Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 28144611A | IN |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 71004923A | IN |
NPI | 1033520101 |
---|---|
Provider Name | Mrs. Oluyinka Grace Osunnuga |
First Address | Mishawaka, IN 46545-5006 |
Second Address | Mishawaka, IN 46545-5006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2014 |
Last Update Date | 25/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201230310 | (05) | IN |