Provider Demographics
NPI:1063238723
Name:OGUNKUADE, IFEOLUWA O
Entity type:Individual
Prefix:
First Name:IFEOLUWA
Middle Name:O
Last Name:OGUNKUADE
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 1:1360 VISTA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3281
Mailing Address - Country:US
Mailing Address - Phone:331-771-1132
Mailing Address - Fax:
Practice Address - Street 1:1360 VISTA RIDGE DR
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-3281
Practice Address - Country:US
Practice Address - Phone:331-771-1132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH522681163WH0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health