MEDICARE: IMUWAHEN N ASEMOTA RN

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	4704358682	MI

General Provider Information

NPI Number	:	1205548781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IMUWAHEN N ASEMOTA RN

Provider Business Mailing Address
First Line	:	2154 KENNEDY DR # A
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-2900
Country	:	US
Telephone Number	:	517-215-6436
Fax Number	:

Provider Business Practice Location Address
First Line	:	2154 KENNEDY DR # A
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-2900
Country	:	US
Telephone Number	:	517-215-6436
Fax Number	:

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

Provider Enumeration Date	:	12/16/2022
Last Update Date	:	12/16/2022

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