Healthcare Provider Details

I. General information

NPI: 1730629122
Provider Name (Legal Business Name): KEHINDE ALABI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2017
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 SW SAGERT ST APT 95
TUALATIN OR
97062-9234
US

IV. Provider business mailing address

7800 SW SAGERT ST APT 95
TUALATIN OR
97062-9234
US

V. Phone/Fax

Practice location:
  • Phone: 503-998-9374
  • Fax:
Mailing address:
  • Phone: 503-998-9374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number201600348RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: