Provider Demographics
NPI:1952657066
Name:ATANDA, OLATUNDE MICHAEL (RN)
Entity Type:Individual
Prefix:
First Name:OLATUNDE
Middle Name:MICHAEL
Last Name:ATANDA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4814 CROSSCREEK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-6190
Mailing Address - Country:US
Mailing Address - Phone:614-218-1700
Mailing Address - Fax:
Practice Address - Street 1:4814 CROSSCREEK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-6190
Practice Address - Country:US
Practice Address - Phone:614-218-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.381794163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse