Provider Demographics
NPI:1780105247
Name:OJO, IDITH OBEHI (CRNP)
Entity type:Individual
Prefix:DR
First Name:IDITH
Middle Name:OBEHI
Last Name:OJO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:DR
Other - First Name:IDITH
Other - Middle Name:O
Other - Last Name:OJO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:501 S 54TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-1900
Mailing Address - Country:US
Mailing Address - Phone:215-748-9707
Mailing Address - Fax:
Practice Address - Street 1:7439 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-3600
Practice Address - Country:US
Practice Address - Phone:215-821-7336
Practice Address - Fax:215-827-5585
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily