Provider Demographics
NPI:1932443918
Name:OBENG, EDITH (CNA)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:OBENG
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 LORD BARTON DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-7480
Mailing Address - Country:US
Mailing Address - Phone:540-412-9480
Mailing Address - Fax:540-412-9480
Practice Address - Street 1:7200 LORD BARTON DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-7480
Practice Address - Country:US
Practice Address - Phone:540-412-9480
Practice Address - Fax:540-412-9480
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA8704198374U00000X
VA1401116318376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA202040173OtherEIN
VA$$$$$$$$$OtherSSN