Healthcare Provider Details

I. General information

NPI: 1306200696
Provider Name (Legal Business Name): MOSES KOLAWOLE OLOFIN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 RICHIE AVE
LIMA OH
45801-3929
US

IV. Provider business mailing address

850 RICHIE AVE
LIMA OH
45801-3929
US

V. Phone/Fax

Practice location:
  • Phone: 419-371-6502
  • Fax:
Mailing address:
  • Phone: 419-371-6502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0037395
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.425332
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: