Provider Demographics
NPI:1891689147
Name:OKE, OMOWUNMI GRACE
Entity type:Individual
Prefix:
First Name:OMOWUNMI
Middle Name:GRACE
Last Name:OKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5503 NIGHTHAWK WAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-4771
Mailing Address - Country:US
Mailing Address - Phone:317-640-1713
Mailing Address - Fax:877-781-5107
Practice Address - Street 1:5503 NIGHTHAWK WAY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-4771
Practice Address - Country:US
Practice Address - Phone:317-640-1713
Practice Address - Fax:877-781-5107
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN24-018334-13747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider