Provider Demographics
NPI:1871935247
Name:OBINERO, AUDREY NNENNA (NP-C)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:NNENNA
Last Name:OBINERO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 785
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73502-0785
Mailing Address - Country:US
Mailing Address - Phone:580-357-9984
Mailing Address - Fax:580-357-3277
Practice Address - Street 1:3811 W GORE BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6310
Practice Address - Country:US
Practice Address - Phone:580-250-6525
Practice Address - Fax:580-354-5930
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF306154-1363LA2200X
OK114594363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health