Healthcare Provider Details

I. General information

NPI: 1295389740
Provider Name (Legal Business Name): ESTHER A OGUNDARE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

394 NAPLES PL.
WESTERVILLE OH
43081
US

IV. Provider business mailing address

394 NAPLES PL.
WESTERVILLE OH
43081
US

V. Phone/Fax

Practice location:
  • Phone: 614-260-3350
  • Fax:
Mailing address:
  • Phone: 614-260-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.171473.MED-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: