Provider Demographics
NPI:1144572637
Name:OSAZUWA, ETHEL OSAYIWENSE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:ETHEL
Middle Name:OSAYIWENSE
Last Name:OSAZUWA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 DE REIMER AVE
Mailing Address - Street 2:PH
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2127
Mailing Address - Country:US
Mailing Address - Phone:646-696-4849
Mailing Address - Fax:
Practice Address - Street 1:4125 DE REIMER AVE
Practice Address - Street 2:PH
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2127
Practice Address - Country:US
Practice Address - Phone:646-696-4849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311254-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse