Individual
MR. TONY EHIMARE OMOAREBUN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11460 RIVERSTONE TRL, WOODBURY, MN 55129-3002
(651) 353-4902
Mailing address
11460 RIVERSTONE TRL, WOODBURY, MN 55129-3002
(651) 353-4902
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
10/30/2021
Last updated
10/30/2021
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