Provider Demographics
NPI:1487379962
Name:JOSHUA, OLUBUNMI
Entity type:Individual
Prefix:
First Name:OLUBUNMI
Middle Name:
Last Name:JOSHUA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 CREEKPARK CT
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-8084
Mailing Address - Country:US
Mailing Address - Phone:240-619-9866
Mailing Address - Fax:
Practice Address - Street 1:638 CREEKPARK CT
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-8084
Practice Address - Country:US
Practice Address - Phone:240-619-9866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
OH521027163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide