MEDICARE: OLUBUNMI YEMISI ABODUNRIN

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	163W00000X	Registered Nurse	4704250841	MI
2	163WH0200X	Home Health Registered Nurse	4704250841	MI

General Provider Information

NPI Number	:	1437494440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUBUNMI YEMISI ABODUNRIN

Provider Business Mailing Address
First Line	:	1669 EMERALD PINES DR
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-2236
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1669 EMERALD PINES DR
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-2236
Country	:	US
Telephone Number	:	734-738-1182
Fax Number	:

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

Provider Enumeration Date	:	12/02/2012
Last Update Date	:	12/02/2012

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