Healthcare Provider Details

I. General information

NPI: 1518526458
Provider Name (Legal Business Name): OLAMIDE ENITAN LARKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 E MOUNTAIN VIEW RD STE 220
SCOTTSDALE AZ
85258-5172
US

IV. Provider business mailing address

5697 GREEN CIRCLE DR APT 205
MINNETONKA MN
55343-9644
US

V. Phone/Fax

Practice location:
  • Phone: 877-564-3627
  • Fax:
Mailing address:
  • Phone: 612-481-6193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number6606
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6606
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: