Healthcare Provider Details

I. General information

NPI: 1164880597
Provider Name (Legal Business Name): MRS. FOLASHADE S OBASA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2016
Last Update Date: 01/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13723 RUGBY RD
CLEVELAND OH
44110-2238
US

IV. Provider business mailing address

13723 RUGBY RD
CLEVELAND OH
44110-2238
US

V. Phone/Fax

Practice location:
  • Phone: 216-622-5364
  • Fax:
Mailing address:
  • Phone: 216-622-5364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN161116
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: