Provider Demographics
NPI:1124378302
Name:OBASEKI, REBECCA OSARO (RN)
Entity type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:OSARO
Last Name:OBASEKI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 THOMAS BOYLAND ST.
Mailing Address - Street 2:APT. 22D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233
Mailing Address - Country:US
Mailing Address - Phone:718-346-8412
Mailing Address - Fax:
Practice Address - Street 1:249 THOMAS BOYLAND ST.
Practice Address - Street 2:APT. 22D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233
Practice Address - Country:US
Practice Address - Phone:718-346-8412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY581882-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse