Provider Demographics
NPI:1508603846
Name:AROWOBUSOYE, MARIAM
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:AROWOBUSOYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 CARLA LN
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-5429
Mailing Address - Country:US
Mailing Address - Phone:262-744-1651
Mailing Address - Fax:
Practice Address - Street 1:1308 CARLA LN
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-5429
Practice Address - Country:US
Practice Address - Phone:262-744-1651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty