Healthcare Provider Details

I. General information

NPI: 1467757070
Provider Name (Legal Business Name): TITILOLA FOLASADE OBAFUNWA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 Q ST
LINCOLN NE
68508-2345
US

IV. Provider business mailing address

110 Q ST
LINCOLN NE
68508-2345
US

V. Phone/Fax

Practice location:
  • Phone: 402-817-0980
  • Fax:
Mailing address:
  • Phone: 402-817-0980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number111198
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: