Healthcare Provider Details

I. General information

NPI: 1093093262
Provider Name (Legal Business Name): DR. OLUTOYIN TITILAYO OWHE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLUTOYIN TITILAYO FAMUYIDE D.DIV., MHA, RN

II. Dates (important events)

Enumeration Date: 07/22/2011
Last Update Date: 07/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 CUMBERLAND ST W
COWAN TN
37318-3112
US

IV. Provider business mailing address

328 CUMBERLAND ST W
COWAN TN
37318-3112
US

V. Phone/Fax

Practice location:
  • Phone: 931-962-3102
  • Fax: 931-962-9911
Mailing address:
  • Phone: 931-691-3102
  • Fax: 931-962-9911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000180865
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number0000002140
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: