Provider Demographics
NPI:1104358704
Name:OSUEKE, RUTH OLA (FNP)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:OLA
Last Name:OSUEKE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13220 JENKINS ST NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-4951
Mailing Address - Country:US
Mailing Address - Phone:678-232-5366
Mailing Address - Fax:
Practice Address - Street 1:2106 LINDLEY LN NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5232
Practice Address - Country:US
Practice Address - Phone:678-232-5366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-01
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN202526363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily