Healthcare Provider Details

I. General information

NPI: 1477393098
Provider Name (Legal Business Name): EVELYN OLUOHA DNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2542 HILGARD AVE
BERKELEY CA
94709-1105
US

IV. Provider business mailing address

2542 HILGARD AVE
BERKELEY CA
94709-1105
US

V. Phone/Fax

Practice location:
  • Phone: 312-593-5205
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95026222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: