Provider Demographics
NPI:1083357917
Name:IDOWU, CHRISTIANAH O (CNA)
Entity Type:Individual
Prefix:
First Name:CHRISTIANAH
Middle Name:O
Last Name:IDOWU
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:CHRISTIANAH
Other - Middle Name:O
Other - Last Name:AKINBILE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:6229 POLAR FOX CT
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-2356
Mailing Address - Country:US
Mailing Address - Phone:404-902-9892
Mailing Address - Fax:
Practice Address - Street 1:6229 POLAR FOX CT
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-2356
Practice Address - Country:US
Practice Address - Phone:404-902-9892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0014189242376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide