Provider Demographics
NPI:1770190753
Name:OBIANKE, JULIUS OSABOR
Entity Type:Individual
Prefix:
First Name:JULIUS
Middle Name:OSABOR
Last Name:OBIANKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 FALLON DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-1210
Mailing Address - Country:US
Mailing Address - Phone:469-288-1333
Mailing Address - Fax:
Practice Address - Street 1:1000 FALLON DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-1210
Practice Address - Country:US
Practice Address - Phone:469-288-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1010543363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care