Provider Demographics
NPI:1861464083
Name:OBREMSKI, TANIA (NP)
Entity Type:Individual
Prefix:MS
First Name:TANIA
Middle Name:
Last Name:OBREMSKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2577 W. 5TH ST.
Mailing Address - Street 2:WALTER B. JONES ALCOHOL AND DRUG ABUSE TREATMENT CENTER
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834
Mailing Address - Country:US
Mailing Address - Phone:252-830-3426
Mailing Address - Fax:
Practice Address - Street 1:2577 W 5TH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7813
Practice Address - Country:US
Practice Address - Phone:252-830-3426
Practice Address - Fax:252-830-8585
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09-00117363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000223Medicaid
NC500002093OtherRAILROAD MEDICARE
NCS39378Medicare UPIN
NC7000223Medicaid