MEDICARE: IDOWU OLAMIDE OGUNSEYIN LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	PN: 131564	OH

General Provider Information

NPI Number	:	1053624783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IDOWU OLAMIDE OGUNSEYIN LPN

Provider Business Mailing Address
First Line	:	5732 PINE TREE ST W
Second Line	:	APT.K
City	:	COLUMBUS
State	:	OH
Zip	:	43229-3789
Country	:	US
Telephone Number	:	614-806-9087
Fax Number	:

Provider Business Practice Location Address
First Line	:	5732 PINE TREE ST W
Second Line	:	APT.K
City	:	COLUMBUS
State	:	OH
Zip	:	43229-3789
Country	:	US
Telephone Number	:	614-806-9087
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2010
Last Update Date	:	07/22/2010

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