Provider Demographics
NPI:1700440823
Name:OWOLABI, OLUFUNKE ELIZABETH
Entity Type:Individual
Prefix:
First Name:OLUFUNKE
Middle Name:ELIZABETH
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 1:1119 KEYSTONE WAY
Mailing Address - Street 2:STE 201B
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3356
Mailing Address - Country:US
Mailing Address - Phone:317-214-2100
Mailing Address - Fax:317-214-2101
Practice Address - Street 1:4921 ASPEN CREST LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-9514
Practice Address - Country:US
Practice Address - Phone:317-666-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF04190305363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily