Individual
JACKLYN OBENG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
624 W MAIN ST, NORWICH, CT 06360-6043
(860) 200-8098
Mailing address
1290 SILAS DEANE HWY FL 1, WETHERSFIELD, CT 06109-4337
(860) 972-6970
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
005901
CT
363LF0000X
Family Nurse Practitioner
338443-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04001781
—
NY
Enumeration date
09/04/2014
Last updated
03/09/2021
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