Healthcare Provider Details

I. General information

NPI: 1790988145
Provider Name (Legal Business Name): MS. ADEREMI FOLASHADE OWOEYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 SCENIC CT
HACKETTSTOWN NJ
07840-1745
US

IV. Provider business mailing address

50 SCENIC CT
HACKETTSTOWN NJ
07840-1745
US

V. Phone/Fax

Practice location:
  • Phone: 908-684-0311
  • Fax: 908-684-0211
Mailing address:
  • Phone: 908-684-0311
  • Fax: 908-684-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License Number26NR12816800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: