Provider Demographics
NPI:1841742806
Name:OULANYAH, LADYWINNIE AMOO (HIM)
Entity Type:Individual
Prefix:
First Name:LADYWINNIE
Middle Name:AMOO
Last Name:OULANYAH
Suffix:
Gender:F
Credentials:HIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8261 E KENYON DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-4273
Mailing Address - Country:US
Mailing Address - Phone:619-578-8416
Mailing Address - Fax:520-844-6840
Practice Address - Street 1:3230 N CRAYCROFT RD APT 1
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-5246
Practice Address - Country:US
Practice Address - Phone:619-578-8416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ376G00000X
172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator