Provider Demographics
NPI:1447299839
Name:EFETEVBIA, OMOEFE (NP-C)
Entity type:Individual
Prefix:MR
First Name:OMOEFE
Middle Name:
Last Name:EFETEVBIA
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6106 COOPER WOODS DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8775
Mailing Address - Country:US
Mailing Address - Phone:614-778-1738
Mailing Address - Fax:
Practice Address - Street 1:6106 COOPER WOODS DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8775
Practice Address - Country:US
Practice Address - Phone:614-778-1738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP026259363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily