Provider Demographics
NPI:1346079571
Name:OYIBO, OWA I (RN)
Entity type:Individual
Prefix:
First Name:OWA
Middle Name:I
Last Name:OYIBO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 ROCK MANOR WAY
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-7698
Mailing Address - Country:US
Mailing Address - Phone:770-337-6778
Mailing Address - Fax:
Practice Address - Street 1:3130 ROCK MANOR WAY
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-7698
Practice Address - Country:US
Practice Address - Phone:770-337-6778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-27
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN199711163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse