Provider Demographics
NPI:1619757820
Name:OBINO, PAUL NYABERO (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:NYABERO
Last Name:OBINO
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 SAINT ALBANS AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53714-2706
Mailing Address - Country:US
Mailing Address - Phone:612-423-3606
Mailing Address - Fax:
Practice Address - Street 1:5833 AMERICAN PKWY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-8325
Practice Address - Country:US
Practice Address - Phone:608-230-4632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI252205163WP0808X
WI14675-33363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health