Provider Demographics
NPI:1306200696
Name:OLOFIN, MOSES KOLAWOLE (RN)
Entity Type:Individual
Prefix:MR
First Name:MOSES
Middle Name:KOLAWOLE
Last Name:OLOFIN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 RICHIE AVE
Mailing Address - Street 2:APT#3
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-5923
Mailing Address - Country:US
Mailing Address - Phone:419-371-6502
Mailing Address - Fax:
Practice Address - Street 1:841 RICHIE AVE
Practice Address - Street 2:APT#3
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-5923
Practice Address - Country:US
Practice Address - Phone:419-371-6502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH425332163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse