Provider Demographics
NPI:1346087863
Name:OMORUYI, EDOSA
Entity type:Individual
Prefix:
First Name:EDOSA
Middle Name:
Last Name:OMORUYI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6606 DOVE TRAIL LN
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-3611
Mailing Address - Country:US
Mailing Address - Phone:614-312-4170
Mailing Address - Fax:
Practice Address - Street 1:6606 DOVE TRAIL LN
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-3611
Practice Address - Country:US
Practice Address - Phone:614-312-4170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide