Healthcare Provider Details

I. General information

NPI: 1770147100
Provider Name (Legal Business Name): DR. REBECCA OLOWU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1969 W HART RD
BELOIT WI
53511-2230
US

IV. Provider business mailing address

1641 SAINT MARKS AVE APT 1R
BROOKLYN NY
11233-6112
US

V. Phone/Fax

Practice location:
  • Phone: 608-364-5689
  • Fax:
Mailing address:
  • Phone: 312-684-3392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number99999
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number81019
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: