Provider Demographics
NPI:1265667570
Name:OMONIWA, YETUNDE
Entity Type:Individual
Prefix:
First Name:YETUNDE
Middle Name:
Last Name:OMONIWA
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 1:120 RUTH ELLEN DR APT H303
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1059
Mailing Address - Country:US
Mailing Address - Phone:216-374-5430
Mailing Address - Fax:216-797-1772
Practice Address - Street 1:120 RUTH ELLEN DR
Practice Address - Street 2:APT H303
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-1059
Practice Address - Country:US
Practice Address - Phone:216-374-5430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-16
Last Update Date:2009-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH323233590605376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide