Provider Demographics
NPI:1902307853
Name:OBRIQUE, JOHN ROBERT LAGMAN (CNA)
Entity Type:Individual
Prefix:
First Name:JOHN ROBERT
Middle Name:LAGMAN
Last Name:OBRIQUE
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 W 1200 S
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-2843
Mailing Address - Country:US
Mailing Address - Phone:801-546-8884
Mailing Address - Fax:
Practice Address - Street 1:19 W 1200 S
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-2843
Practice Address - Country:US
Practice Address - Phone:801-546-8884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCNA036225376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide