Provider Demographics
NPI:1669295226
Name:MADUBUIKE, OBIOMA QUEENETH (PSYCH NP)
Entity type:Individual
Prefix:MISS
First Name:OBIOMA
Middle Name:QUEENETH
Last Name:MADUBUIKE
Suffix:
Gender:F
Credentials:PSYCH NP
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Mailing Address - Street 1:1801 N HAMPTON RD STE 421
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2391
Mailing Address - Country:US
Mailing Address - Phone:214-208-1358
Mailing Address - Fax:
Practice Address - Street 1:1801 N HAMPTON RD STE 421
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2391
Practice Address - Country:US
Practice Address - Phone:214-208-1358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX924523163WP0807X
TX1179274363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent