Provider Demographics
NPI:1649622739
Name:OWOLABI, NANA
Entity type:Individual
Prefix:
First Name:NANA
Middle Name:
Last Name:OWOLABI
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 1:9062 PINEVIEW LN
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-1584
Mailing Address - Country:US
Mailing Address - Phone:219-750-9910
Mailing Address - Fax:
Practice Address - Street 1:9062 PINEVIEW LN
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-1584
Practice Address - Country:US
Practice Address - Phone:219-750-9910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver