Provider Demographics
NPI:1093267494
Name:OMILANA, OPEYEMI RUTH
Entity Type:Individual
Prefix:
First Name:OPEYEMI
Middle Name:RUTH
Last Name:OMILANA
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 1:857 21ST ST NE
Mailing Address - Street 2:APT. 10
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4139
Mailing Address - Country:US
Mailing Address - Phone:202-602-7765
Mailing Address - Fax:
Practice Address - Street 1:857 21ST ST NE
Practice Address - Street 2:APT. 10
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4139
Practice Address - Country:US
Practice Address - Phone:202-602-7765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
DCHHA12435374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide