Healthcare Provider Details

I. General information

NPI: 1750141362
Provider Name (Legal Business Name): OLUWASEUN KEHINDE IDOWU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3837 CHICKASAW DR
GROVE CITY OH
43123-3847
US

IV. Provider business mailing address

3837 CHICKASAW DR
GROVE CITY OH
43123-3847
US

V. Phone/Fax

Practice location:
  • Phone: 973-342-3283
  • Fax:
Mailing address:
  • Phone: 973-342-3283
  • 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: