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General NPI Number Information
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NPI Number | 1194385500
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Entity Type | Individual
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Provider Name | ADESUWA IYOHA
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Gender | Female
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Dates
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Enumeration Date | 06/18/2019
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Last Update Date | 06/18/2019
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Provider Practice Location Address
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Address Line | 30509 HALECREEK ST
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City | ROMULUS
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State | MI
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Zip | 48174-3224
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Country | US
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Telephone | 734-992-4894
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Fax | 734-221-5850
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Provider Business Mailing Address
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Address Line | PO BOX 3011
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City | ANN ARBOR
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State | MI
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Zip | 48106-3011
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Country | US
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Telephone | 734-846-7884
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Fax | 734-221-5850
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AS820317288
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License Number State | MI
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