Healthcare Provider Details

I. General information

NPI: 1447092473
Provider Name (Legal Business Name): FOLA PIUS AKINNUSI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 33RD AVE S APT 105
FARGO ND
58104-6571
US

IV. Provider business mailing address

2201 33RD AVE S APT 105
FARGO ND
58104-6571
US

V. Phone/Fax

Practice location:
  • Phone: 302-250-6189
  • Fax:
Mailing address:
  • Phone: 302-250-6189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: