Individual
AYODEJI OGUNDARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
9230 OLD NEWTOWN RD, PHILADELPHIA, PA 19115-4908
(267) 475-2834
Mailing address
9230 OLD NEWTOWN RD, PHILADELPHIA, PA 19115-4908
(267) 475-2834
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
303623
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NA
—
PA
Enumeration date
10/12/2017
Last updated
06/16/2018
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