Healthcare Provider Details

I. General information

NPI: 1518326099
Provider Name (Legal Business Name): MARIAN OWOLABI CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S WASHINGTON ST
VAN WERT OH
45891-2551
US

IV. Provider business mailing address

9014 TARPLEYS CIRCLE
BALTIMORE MD
21237
US

V. Phone/Fax

Practice location:
  • Phone: 419-238-2390
  • Fax:
Mailing address:
  • Phone: 443-834-2613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR199703
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number18987NP
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26NJ01023400
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ01023400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: