Provider Demographics
NPI:1528791001
Name:ESUTURIE, ONOME
Entity type:Individual
Prefix:
First Name:ONOME
Middle Name:
Last Name:ESUTURIE
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 1:330 LYNNWAY STE 112
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1706
Mailing Address - Country:US
Mailing Address - Phone:781-842-0613
Mailing Address - Fax:
Practice Address - Street 1:330 LYNNWAY STE 112
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1706
Practice Address - Country:US
Practice Address - Phone:781-842-0613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-02
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2278078363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health