Provider Demographics
NPI:1831749720
Name:OBU, GABRIEL NWANNEBUIKE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:NWANNEBUIKE
Last Name:OBU
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0508
Mailing Address - Country:US
Mailing Address - Phone:832-945-1414
Mailing Address - Fax:
Practice Address - Street 1:535 SE WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4142
Practice Address - Country:US
Practice Address - Phone:503-755-6703
Practice Address - Fax:503-755-6704
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1089146363LP0808X
WAAP61378181363LP0808X
NM70473363LP0808X
MDAC005902363LP0808X
AZ296197363LP0808X
OR10019946363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP61378181OtherPSYCHIATRIC NURSE PRACTITIONER
NM70473OtherPSYCHIATRIC NURSE PRACTITIONER
AZ296197OtherPSYCHIATRIC NURSE PRACTITIONER
TX1089146OtherPSYCHIATRIC NURSE PRACTITIONER
MDAC005902OtherPSYCHIATRIC NURSE PRACTITIONER