Healthcare Provider Details

I. General information

NPI: 1407276603
Provider Name (Legal Business Name): NDIDI OLOGN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2014
Last Update Date: 01/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5161 HAMPSTED VILLAGE CENTER WAY
NEW ALBANY OH
43054-8329
US

IV. Provider business mailing address

5161 HAMPSTED VILLAGE CENTER WAY
NEW ALBANY OH
43054-8329
US

V. Phone/Fax

Practice location:
  • Phone: 614-000-0000
  • Fax:
Mailing address:
  • Phone: 614-000-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number000000
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: