Provider Demographics
NPI:1922341981
Name:ODOLA, NYGWO OJULU
Entity Type:Individual
Prefix:MR
First Name:NYGWO
Middle Name:OJULU
Last Name:ODOLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 S 9TH ST APT 309
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-1123
Mailing Address - Country:US
Mailing Address - Phone:612-558-1263
Mailing Address - Fax:
Practice Address - Street 1:706 SOUTH 9TH STREET APT 309
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404
Practice Address - Country:US
Practice Address - Phone:612-558-1263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health