Provider Demographics
NPI:1922557776
Name:TAIWO, OMOLAYO (NP)
Entity Type:Individual
Prefix:
First Name:OMOLAYO
Middle Name:
Last Name:TAIWO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11939 RIVER HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-1354
Mailing Address - Country:US
Mailing Address - Phone:651-235-8198
Mailing Address - Fax:
Practice Address - Street 1:11939 RIVER HILLS DR
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-1354
Practice Address - Country:US
Practice Address - Phone:651-235-8198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP 4793363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily