Provider Demographics
NPI:1528889623
Name:OSAZEMWINDE, LAURETTA OSARODION
Entity type:Individual
Prefix:
First Name:LAURETTA
Middle Name:OSARODION
Last Name:OSAZEMWINDE
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 1:760 WESTBURY DR
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-1560
Mailing Address - Country:US
Mailing Address - Phone:614-452-3241
Mailing Address - Fax:
Practice Address - Street 1:760 WESTBURY DR
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-1560
Practice Address - Country:US
Practice Address - Phone:614-452-3241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH602842160524376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide