Provider Demographics
NPI:1669521449
Name:WOBO, NELSON N (BA)
Entity type:Individual
Prefix:MR
First Name:NELSON
Middle Name:N
Last Name:WOBO
Suffix:
Gender:M
Credentials:BA
Other - Prefix:MRS
Other - First Name:NNENNA
Other - Middle Name:M
Other - Last Name:WOBO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ASSOCIATE
Mailing Address - Street 1:3013 RANBURNE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-3674
Mailing Address - Country:US
Mailing Address - Phone:919-832-1005
Mailing Address - Fax:
Practice Address - Street 1:3013 RANBURNE DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-3674
Practice Address - Country:US
Practice Address - Phone:919-832-1005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3553171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator