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General NPI Number Information
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NPI Number | 1184197691
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Entity Type | Individual
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Provider Name | WAHEED OLAWOYIN OLABODE NP
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Gender | Male
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Dates
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Enumeration Date | 01/08/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 12853 S 184TH AVE
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City | GOODYEAR
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State | AZ
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Zip | 85338-2642
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Country | US
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Telephone | 503-333-0174
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Fax |
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Provider Business Mailing Address
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Address Line | 14780 W MOUNTAIN VIEW BLVD STE 110
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City | SURPRISE
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State | AZ
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Zip | 85374-7280
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Country | US
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Telephone | 623-777-7973
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 220581
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License Number State | AZ
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