Provider Demographics
NPI:1972320281
Name:OGUNMUYIWA, CAROLINE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:OGUNMUYIWA
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12212 FAWNHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-1323
Mailing Address - Country:US
Mailing Address - Phone:202-531-5924
Mailing Address - Fax:
Practice Address - Street 1:12212 FAWNHAVEN CT
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-1323
Practice Address - Country:US
Practice Address - Phone:202-531-5924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR206341163WH0200X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WH0200XNursing Service ProvidersRegistered NurseHome Health