| Doctor Name: | THERESA OBONYANO |
| NPI Number: | 1548627268 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 783059 |
| Business Practice Address: | 3618 Mustang Ln Manvel, TX - 775783575 |
| Business Phone Number: | 3176256765 |
| Business Fax Number: | |
| Mailing Address: | 3618 Mustang Ln, MANVEL |
| State: | TX |
| Postal Code: | 775783575 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 01/26/2016 |
| NPI Last Update Date: | 05/31/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 783059 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |