Provider Demographics
NPI:1891468807
Name:OBI, CHARLES CHISOM (RN)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:CHISOM
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 1:300 CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:RIVER ROUGE
Mailing Address - State:MI
Mailing Address - Zip Code:48218-1011
Mailing Address - Country:US
Mailing Address - Phone:313-744-2001
Mailing Address - Fax:
Practice Address - Street 1:300 CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:RIVER ROUGE
Practice Address - State:MI
Practice Address - Zip Code:48218-1011
Practice Address - Country:US
Practice Address - Phone:313-744-2001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty