Healthcare Provider Details

I. General information

NPI: 1528609690
Provider Name (Legal Business Name): OLANREWAJU HAKEEM BARUWA NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 WATERMAN AVE
EAST PROVIDENCE RI
02914-3523
US

IV. Provider business mailing address

400 MINERAL SPRING AVE APT 27
PAWTUCKET RI
02860-3587
US

V. Phone/Fax

Practice location:
  • Phone: 401-431-2087
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN02173
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: