Provider Demographics
NPI:1730636093
Name:ORUMWENSE, ABIEYUWA
Entity Type:Individual
Prefix:
First Name:ABIEYUWA
Middle Name:
Last Name:ORUMWENSE
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 1:7515 STENTON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-3710
Mailing Address - Country:US
Mailing Address - Phone:215-823-6322
Mailing Address - Fax:
Practice Address - Street 1:7515 STENTON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-3710
Practice Address - Country:US
Practice Address - Phone:215-823-6322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-04
Last Update Date:2016-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008324363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health