Provider Demographics
NPI:1700041373
Name:OBI, IFEOMA O (RN)
Entity Type:Individual
Prefix:MISS
First Name:IFEOMA
Middle Name:O
Last Name:OBI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4830 N 47TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-4414
Mailing Address - Country:US
Mailing Address - Phone:414-732-8731
Mailing Address - Fax:
Practice Address - Street 1:13705 W GREEN MEADOW DR
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-3135
Practice Address - Country:US
Practice Address - Phone:262-786-6974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI157236-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse