Healthcare Provider Details

I. General information

NPI: 1093531907
Provider Name (Legal Business Name): MRS. YEWANDE OLAJUMOKE OLANREWAJU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7775 TERRI DR
WESTLAND MI
48185-9449
US

IV. Provider business mailing address

7775 TERRI DR
WESTLAND MI
48185-9449
US

V. Phone/Fax

Practice location:
  • Phone: 734-444-6492
  • Fax:
Mailing address:
  • Phone: 734-444-6492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: