Provider Demographics
NPI:1780230474
Name:EDUOK, OTO-OBONG
Entity type:Individual
Prefix:
First Name:OTO-OBONG
Middle Name:
Last Name:EDUOK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 RAVEN CLIFF LN
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-5340
Mailing Address - Country:US
Mailing Address - Phone:504-701-5607
Mailing Address - Fax:
Practice Address - Street 1:107 RAVEN CLIFF LN
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-5340
Practice Address - Country:US
Practice Address - Phone:504-701-5607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-17
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA203681363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care