Basic Information
| Provider Information | |||||||||
| NPI: | 1114423514 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OPARA | ||||||||
| FirstName: | OBIAGERI | ||||||||
| MiddleName: | RITA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4160 JOHN R ST STE 930 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137457247 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4160 JOHN R ST STE 930 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137457247 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2018 | ||||||||
| LastUpdateDate: | 04/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 4704289240 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LP2300X | 4704289240 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 363LF0000X | 4704289240 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.