Provider Demographics
NPI:1104480847
Name:OBI-IGBEDI, ALICE ONONUJU
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:ONONUJU
Last Name:OBI-IGBEDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 PINION DR APT 308
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-6171
Mailing Address - Country:US
Mailing Address - Phone:256-288-2355
Mailing Address - Fax:
Practice Address - Street 1:902 PINION DR APT 308
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-6171
Practice Address - Country:US
Practice Address - Phone:256-288-2355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX964060163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse