Individual
MR. SAMSON EBHO OSEBOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
240 BEAR HILL RD STE 104, WALTHAM, MA 02451-1026
(617) 340-3559
Mailing address
667 MAIN ST APT 29, WOBURN, MA 01801-2377
(781) 249-8007
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN2311226
MA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN2311226
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S92075712
DRIVER LICENSE
MA
Enumeration date
07/20/2022
Last updated
03/11/2024
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