Provider Demographics
NPI:1588913073
Name:EGODOTAYE, LAWRETTA ONYEBUCHI (RN)
Entity type:Individual
Prefix:MRS
First Name:LAWRETTA
Middle Name:ONYEBUCHI
Last Name:EGODOTAYE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:LAWRETTA
Other - Middle Name:ONYEBUCHI
Other - Last Name:ANAZIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5881 TROY VILLA BLVD
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-2649
Mailing Address - Country:US
Mailing Address - Phone:937-718-6471
Mailing Address - Fax:
Practice Address - Street 1:5881 TROY VILLA BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-2649
Practice Address - Country:US
Practice Address - Phone:937-718-6471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH366272163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse