Provider Demographics
NPI:1083273528
Name:OGUNLOWO, KYANDRA
Entity Type:Individual
Prefix:
First Name:KYANDRA
Middle Name:
Last Name:OGUNLOWO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6466 N ESPANA CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80019-2169
Mailing Address - Country:US
Mailing Address - Phone:303-522-4235
Mailing Address - Fax:
Practice Address - Street 1:6466 N ESPANA CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80019-2169
Practice Address - Country:US
Practice Address - Phone:303-522-4235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-09
Last Update Date:2019-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPN0331882164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse