Provider Demographics
NPI:1255175527
Name:AWOSOJI, OMOTAYO AMOS
Entity type:Individual
Prefix:MR
First Name:OMOTAYO
Middle Name:AMOS
Last Name:AWOSOJI
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 1:1005 GRAY DR
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-9394
Mailing Address - Country:US
Mailing Address - Phone:614-500-0341
Mailing Address - Fax:
Practice Address - Street 1:1005 GRAY DR
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9394
Practice Address - Country:US
Practice Address - Phone:614-500-0341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN529335163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical