Provider Demographics
NPI:1417229097
Name:AWE-ODIGIE, OMOWUMI SUSAN
Entity Type:Individual
Prefix:MRS
First Name:OMOWUMI
Middle Name:SUSAN
Last Name:AWE-ODIGIE
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 1:25721 145TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-3314
Mailing Address - Country:US
Mailing Address - Phone:718-978-6841
Mailing Address - Fax:718-978-6841
Practice Address - Street 1:25721 145TH AVE
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-3314
Practice Address - Country:US
Practice Address - Phone:718-978-6841
Practice Address - Fax:718-978-6841
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY479075-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse