Provider Demographics
NPI:1699074252
Name:OBENG, MATILDA N (MSN, APRN)
Entity type:Individual
Prefix:MS
First Name:MATILDA
Middle Name:N
Last Name:OBENG
Suffix:
Gender:F
Credentials:MSN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5410 ASTER PARK DR
Mailing Address - Street 2:APT 701
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45011-9481
Mailing Address - Country:US
Mailing Address - Phone:513-275-8083
Mailing Address - Fax:
Practice Address - Street 1:5410 ASTER PARK DR
Practice Address - Street 2:APT 701
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45011-9481
Practice Address - Country:US
Practice Address - Phone:513-275-8083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.386555163W00000X
OH0030951363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse