Provider Demographics
NPI:1164880597
Name:OBASA, FOLASHADE S
Entity Type:Individual
Prefix:MRS
First Name:FOLASHADE
Middle Name:S
Last Name:OBASA
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 1:13723 RUGBY RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44110-2238
Mailing Address - Country:US
Mailing Address - Phone:216-622-5364
Mailing Address - Fax:
Practice Address - Street 1:13723 RUGBY RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44110-2238
Practice Address - Country:US
Practice Address - Phone:216-622-5364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-30
Last Update Date:2016-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN161116164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse