MEDICARE: ANU A OWOFADEJU NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	71010185A	IN
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	28207520A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000001420103	OTHER	IN	ANTHEM PTAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205444775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANU A OWOFADEJU NP

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8820 S MERIDIAN ST STE 225
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46217-6064
Country	:	US
Telephone Number	:	317-865-6922
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2020
Last Update Date	:	11/06/2024

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