Basic Information
| Provider Information | |||||||||
| NPI: | 1518326099 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | OWOLABI | ||||||||
| FirstName: | MARIAN | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9014 TARPLEYS CIRCLE | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4438342613 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1250 S WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | VAN WERT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458912551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192382390 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2016 | ||||||||
| LastUpdateDate: | 01/12/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R199703 | MD | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2100X | 18987NP | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.