Provider Demographics
NPI:1235489816
Name:OLLISON-MUNODAWAFA, KICHELLE NICOLE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KICHELLE
Middle Name:NICOLE
Last Name:OLLISON-MUNODAWAFA
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 1:480 BRITTAIN RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305-2949
Mailing Address - Country:US
Mailing Address - Phone:330-351-5300
Mailing Address - Fax:
Practice Address - Street 1:480 BRITTAIN RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44305-2949
Practice Address - Country:US
Practice Address - Phone:330-351-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.141049-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse