Provider Demographics
NPI:1922832229
Name:OLUBUSOLA, ABISOYE OLUSOLA
Entity type:Individual
Prefix:
First Name:ABISOYE
Middle Name:OLUSOLA
Last Name:OLUBUSOLA
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 1:8989 PHILMONT CURVE DR
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-3591
Mailing Address - Country:US
Mailing Address - Phone:161-420-9783
Mailing Address - Fax:
Practice Address - Street 1:1021 CHECKREIN AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1106
Practice Address - Country:US
Practice Address - Phone:187-741-7455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDD00310476208VP0000X
OH602490550722253Z00000X, 372600000X, 376K00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No253Z00000XAgenciesIn Home Supportive Care
No372600000XNursing Service Related ProvidersAdult Companion
No376K00000XNursing Service Related ProvidersNurse's Aide