Provider Demographics
NPI:1932473709
Name:OBANOR, IZEHIESE IMUWAHEN
Entity Type:Individual
Prefix:MRS
First Name:IZEHIESE
Middle Name:IMUWAHEN
Last Name:OBANOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2419 FAIRBREEZE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-5103
Mailing Address - Country:US
Mailing Address - Phone:832-392-1029
Mailing Address - Fax:
Practice Address - Street 1:2419 FAIRBREEZE DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-5103
Practice Address - Country:US
Practice Address - Phone:832-392-1029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX797980163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse