Healthcare Provider Details

I. General information

NPI: 1447299839
Provider Name (Legal Business Name): OMOEFE EFETEVBIA NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6106 COOPER WOODS DR
WESTERVILLE OH
43081-8775
US

IV. Provider business mailing address

6106 COOPER WOODS DR
WESTERVILLE OH
43081-8775
US

V. Phone/Fax

Practice location:
  • Phone: 614-778-1738
  • Fax:
Mailing address:
  • Phone: 614-778-1738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP026259
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: