Individual
ANU A OWOFADEJU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
8820 S MERIDIAN ST STE 225, INDIANAPOLIS, IN 46217-6064
(317) 865-6922
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
28207520A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71010185A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001420103
ANTHEM PTAN
IN
05
—
300042058
—
IN
Enumeration date
07/21/2020
Last updated
11/06/2024
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