Individual
OMOTAYO BODUNWA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8430 YUCCA LN N, MAPLE GROVE, MN 55369-4671
(612) 481-8047
Mailing address
8430 YUCCA LN N, MAPLE GROVE, MN 55369-4671
(612) 481-8047
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
R-215202-4
MN
Other
Enumeration date
03/20/2017
Last updated
03/20/2017
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