Provider Demographics
NPI:1013425768
Name:OBUABANG, OLIVIA MAAMLE (FNP)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MAAMLE
Last Name:OBUABANG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 KNIGHTSBRIDGE UNIT E
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-3641
Mailing Address - Country:US
Mailing Address - Phone:646-245-9527
Mailing Address - Fax:
Practice Address - Street 1:12 KNIGHTSBRIDGE UNIT E
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-3641
Practice Address - Country:US
Practice Address - Phone:646-245-9527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF342394-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner