Provider Demographics
NPI:1356643357
Name:OLOGBAUMA, ODION JONATHAN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MR
First Name:ODION
Middle Name:JONATHAN
Last Name:OLOGBAUMA
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:400 SOUTH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:HISTORIC NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-5057
Mailing Address - Country:US
Mailing Address - Phone:302-533-6158
Mailing Address - Fax:302-533-6187
Practice Address - Street 1:400 SOUTH ST STE 100
Practice Address - Street 2:
Practice Address - City:HISTORIC NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-5057
Practice Address - Country:US
Practice Address - Phone:302-533-6158
Practice Address - Fax:302-533-6187
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DELB-0000238363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health