MEDICARE: MRS. OLUFUNKE OLAROYEKE AWOWOYIN LPN

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	164X00000X	Licensed Vocational Nurse	149352	OH
2	164X00000X	Licensed Vocational Nurse	149352-M-IV	OH

General Provider Information

NPI Number	:	1679837397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. OLUFUNKE OLAROYEKE AWOWOYIN LPN

Provider Business Mailing Address
First Line	:	3358 ELITE ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-8840
Country	:	US
Telephone Number	:	614-517-2467
Fax Number	:

Provider Business Practice Location Address
First Line	:	3358 ELITE ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-8840
Country	:	US
Telephone Number	:	614-517-2467
Fax Number	:

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

Provider Enumeration Date	:	06/27/2012
Last Update Date	:	06/27/2012

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