Healthcare Provider Details

I. General information

NPI: 1639928120
Provider Name (Legal Business Name): OLAMIDE IDOWU FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 05/16/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 HUGHES RD STE 2100
MADISON AL
35758-3023
US

IV. Provider business mailing address

3408 WALL TRIANA HWY UNIT 21153
HUNTSVILLE AL
35813-2045
US

V. Phone/Fax

Practice location:
  • Phone: 256-325-2772
  • Fax:
Mailing address:
  • Phone: 256-457-4568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-150441
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: