Provider Demographics
NPI:1871661546
Name:OBASEKI, ART O (MSN, FNP)
Entity Type:Individual
Prefix:MR
First Name:ART
Middle Name:O
Last Name:OBASEKI
Suffix:
Gender:M
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-3031
Mailing Address - Country:US
Mailing Address - Phone:812-254-2311
Mailing Address - Fax:812-254-2322
Practice Address - Street 1:1110 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-3031
Practice Address - Country:US
Practice Address - Phone:812-254-2311
Practice Address - Fax:812-254-2322
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN17508Medicare UPIN
INTB2080Medicare ID - Type Unspecified