Healthcare Provider Details

I. General information

NPI: 1538913108
Provider Name (Legal Business Name): VIRGINIA OLUCHI OHUABUNWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 DEER CREEK AVE
INDIANAPOLIS IN
46254-4714
US

IV. Provider business mailing address

5301 DEER CREEK AVE
INDIANAPOLIS IN
46254-4714
US

V. Phone/Fax

Practice location:
  • Phone: 317-702-2994
  • Fax: 317-672-9231
Mailing address:
  • Phone: 317-702-2994
  • Fax: 317-672-9231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number23-014721-1
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: