Healthcare Provider Details

I. General information

NPI: 1356125454
Provider Name (Legal Business Name): MICHAEL OLOWU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5330 E CHARLESTON BLVD UNIT 11
LAS VEGAS NV
89142-1059
US

IV. Provider business mailing address

5330 E CHARLESTON BLVD UNIT 11
LAS VEGAS NV
89142-1059
US

V. Phone/Fax

Practice location:
  • Phone: 702-630-0211
  • Fax:
Mailing address:
  • Phone: 702-630-0211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: