Healthcare Provider Details

I. General information

NPI: 1356638530
Provider Name (Legal Business Name): CHRISTIANAH OLAJUMOKE OGUNTUYI LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2518 DEXHAM CT
COLUMBUS OH
43224-3757
US

IV. Provider business mailing address

108 HAMPTON PARK W
WESTERVILLE OH
43081-5728
US

V. Phone/Fax

Practice location:
  • Phone: 614-822-0043
  • Fax:
Mailing address:
  • Phone: 614-822-0043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.410356
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: