Individual provider · NPI-1

Idriss Owolabi Ayelara

Registered Nurse, Gerontology · Detroit, MI

NPI number1720715303
StatusActive
Last updated in NPPESAug 4, 2022

Details

NPI
1720715303
Entity type
Individual (NPI-1)
Name
Idriss Owolabi Ayelara
Sex
Male
Sole proprietor
Yes
Enumeration date
Aug 4, 2022
Certification date
Aug 4, 2022
Last updated
Aug 4, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
163WG0600X Registered Nurse, Gerontology2011000692MOYes

Practice location

4646 John R St
Detroit, MI 48201-1916

Phone 313-576-1000

Mailing address

4646 John R St
Detroit, MI 48201-1916

Phone 313-576-1000

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