Provider Demographics
NPI:1669082509
Name:OBI-EYISI, AMAUCHE
Entity type:Individual
Prefix:
First Name:AMAUCHE
Middle Name:
Last Name:OBI-EYISI
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 1:4026 DELL LN
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-6610
Mailing Address - Country:US
Mailing Address - Phone:347-575-3678
Mailing Address - Fax:
Practice Address - Street 1:5900 BALCONES DR STE 19443
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4257
Practice Address - Country:US
Practice Address - Phone:469-903-4235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT832363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health