1710291547 NPI number — MRS. OLUFUNKE OMOWUNMI OBATUSIN PLMHP

Table of content: MRS. OLUFUNKE OMOWUNMI OBATUSIN PLMHP (NPI 1710291547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710291547 NPI number — MRS. OLUFUNKE OMOWUNMI OBATUSIN PLMHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OBATUSIN
Provider First Name:
OLUFUNKE
Provider Middle Name:
OMOWUNMI
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PLMHP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OBATUSIN
Provider Other First Name:
OLA
Provider Other Middle Name:
OMOWUNMI
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
COUNSELOR
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1710291547
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
607 CHARLES ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68701-3411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-729-7796
Provider Business Mailing Address Fax Number:
402-371-9643

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 N 34TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68701-3197
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-371-3044
Provider Business Practice Location Address Fax Number:
402-371-9643
Provider Enumeration Date:
08/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  9183 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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