Healthcare Provider Details

I. General information

NPI: 1174358170
Provider Name (Legal Business Name): IYANUOLUWA AFOLABI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2024
Last Update Date: 09/07/2024
Certification Date: 09/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5671 E FOUNTAIN CIR
MASON OH
45040-7312
US

IV. Provider business mailing address

5671 E FOUNTAIN CIR
MASON OH
45040-7312
US

V. Phone/Fax

Practice location:
  • Phone: 513-953-6321
  • Fax:
Mailing address:
  • Phone: 513-953-6321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number602805710924
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: