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General NPI Number Information
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NPI Number | 1356643357
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Entity Type | Individual
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Provider Name | ODION JONATHAN OLOGBAUMA NURSE PRACTITIONER
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Gender | Male
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Dates
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Enumeration Date | 11/23/2010
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Last Update Date | 06/13/2024
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Provider Practice Location Address
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Address Line | 400 SOUTH ST STE 100
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City | HISTORIC NEW CASTLE
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State | DE
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Zip | 19720-5057
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Country | US
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Telephone | 302-533-6158
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Fax | 302-533-6187
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Provider Business Mailing Address
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Address Line | 400 SOUTH ST STE 100
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City | HISTORIC NEW CASTLE
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State | DE
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Zip | 19720-5057
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Country | US
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Telephone | 302-533-6158
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Fax | 302-533-6187
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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 | LB-0000238
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License Number State | DE
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