Individual provider · NPI-1
Omotayo Bodunwa
Home Health Aide · Maple Grove, MN
NPI number1629519947
StatusActive
Last updated in NPPESMar 20, 2017
Details
- NPI
- 1629519947
- Entity type
- Individual (NPI-1)
- Name
- Omotayo Bodunwa
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Mar 20, 2017
- Last updated
- Mar 20, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 374U00000X | Home Health Aide | R-215202-4 | MN | Yes |
Practice location
8430 Yucca Ln NMaple Grove, MN 55369-4671
Phone 612-481-8047
Mailing address
8430 Yucca Ln NMaple Grove, MN 55369-4671
Phone 612-481-8047
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