Provider Demographics
NPI:1194385500
Name:IYOHA, ADESUWA
Entity Type:Individual
Prefix:
First Name:ADESUWA
Middle Name:
Last Name:IYOHA
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:PO BOX 3011
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106-3011
Mailing Address - Country:US
Mailing Address - Phone:734-846-7884
Mailing Address - Fax:734-221-5850
Practice Address - Street 1:30509 HALECREEK ST
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-3224
Practice Address - Country:US
Practice Address - Phone:734-992-4894
Practice Address - Fax:734-221-5850
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS820317288363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health