Healthcare Provider Details

I. General information

NPI: 1922832229
Provider Name (Legal Business Name): ABISOYE OLUSOLA OLUBUSOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 CHECKREIN AVE
COLUMBUS OH
43229-1106
US

IV. Provider business mailing address

8989 PHILMONT CURVE DR
BLACKLICK OH
43004-3591
US

V. Phone/Fax

Practice location:
  • Phone: 187-741-7455
  • Fax:
Mailing address:
  • Phone: 161-420-9783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number602490550722
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number602490550722
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number602490550722
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberDD00310476
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number602490550722
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: