Provider Demographics
NPI:1265971394
Name:ONAMUSI, TEMITAYO I (CNP AGPC)
Entity type:Individual
Prefix:MRS
First Name:TEMITAYO
Middle Name:I
Last Name:ONAMUSI
Suffix:
Gender:F
Credentials:CNP AGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45806-1466
Mailing Address - Country:US
Mailing Address - Phone:419-222-2280
Mailing Address - Fax:
Practice Address - Street 1:904 N CABLE RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805
Practice Address - Country:US
Practice Address - Phone:419-222-9410
Practice Address - Fax:419-222-6175
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN299000363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health