Healthcare Provider Details

I. General information

NPI: 1841115631
Provider Name (Legal Business Name): OLUWAGBEMISOLA DELE-LAWAL
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N INGALLS ST STE 3160
ANN ARBOR MI
48109-2003
US

IV. Provider business mailing address

1105 S 47TH ST
PHILADELPHIA PA
19143-3614
US

V. Phone/Fax

Practice location:
  • Phone: 734-763-5985
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN743857
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: