Provider Demographics
NPI:1255639241
Name:OMORUYI, AMY (RN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:OMORUYI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7992 MISTY SHORE DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-9649
Mailing Address - Country:US
Mailing Address - Phone:301-213-2323
Mailing Address - Fax:
Practice Address - Street 1:2278 HARMONY DR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-4877
Practice Address - Country:US
Practice Address - Phone:301-213-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN132368164W00000X
OHRN.468857163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse