Basic Information
Provider Information
NPI: 1386219590
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OLU
FirstName: MORENIKE
MiddleName: J
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: VCUHS DEPT OF OBGYN 980034
Address2: 1250 E. MARSHALL ST
City: RICHMOND
State: VA
PostalCode: 232980459
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: VCUHS DEPT OF OBGYN 980034
Address2: 1250 E. MARSHALL ST
City: RICHMOND
State: VA
PostalCode: 232980459
CountryCode: US
TelephoneNumber: 8048289783
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/21/2021
LastUpdateDate: 05/21/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/05/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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