Provider Demographics
NPI:1861711467
Name:OBOT, OBOT ASUQUO (REGISTERED NURSE)
Entity type:Individual
Prefix:MR
First Name:OBOT
Middle Name:ASUQUO
Last Name:OBOT
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 REED ST
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-3901
Mailing Address - Country:US
Mailing Address - Phone:716-439-6375
Mailing Address - Fax:716-439-6375
Practice Address - Street 1:20 REED ST
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-3901
Practice Address - Country:US
Practice Address - Phone:716-439-6375
Practice Address - Fax:716-439-6375
Is Sole Proprietor?:No
Enumeration Date:2010-05-21
Last Update Date:2015-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22603954163WP0808X
NY401817363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health