Provider Demographics
NPI:1699182345
Name:OWOYELE, RENEE SABRINA
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:SABRINA
Last Name:OWOYELE
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 1:1572 WOODHURST AVE
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-3406
Mailing Address - Country:US
Mailing Address - Phone:440-600-4238
Mailing Address - Fax:
Practice Address - Street 1:1572 WOODHURST AVE
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-3406
Practice Address - Country:US
Practice Address - Phone:440-600-4238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401093230510376K00000X
OH499241163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0104413Medicaid