Olubukola Awe, NP
Individual provider Active NPI Nurse Practitioner · Waterbury, CT
NPI 1104114149 · NPPES record last updated Mar 17, 2018
Key facts
- NPI
- 1104114149
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 2011009356 (MO)
- Practice address
- 140 Grandview Ave Ste L01
Waterbury, CT 06708-2500 - Phone
- (203) 574-4187
- Fax
- (203) 575-2153
- NPI assigned
- Jul 12, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2010
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Community Health Services Inc
Practice addresses (Care Compare)
500 Albany Ave
Hartford, CT 06120-2508
Phone (860) 249-9625
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170925000124 | CT | Practitioner - Nurse Practitioner | 2062687759 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6748 | CT | MD | Professional Counselor |
| 2011009356 | MO | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alliance Medical Group, Inc | Current |
Accepting new patients | |
| Community Health Services, Inc. | Current |
Accepting new patients | |
| Community Health Services, Inc. | Current |
Accepting new patients |
Locations
500 Albany Ave
Hartford, CT 06120
Phone (860) 249-9625
1625 Straits Tpke
Ste 211
Middlebury, CT 06762
Phone (203) 573-9512
140 Grandview Ave
Ste L01
Waterbury, CT 06708
Phone (203) 574-4187
503 Windsor Ave
Ste 511
Windsor, CT 06095
Interoperability endpoints
- olubukola.awe.p1@direct.chs.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 2011009356 | MO | Yes |
Addresses
Primary practice location
140 Grandview Ave Ste L01
Waterbury, CT 06708-2500
Mailing address
19201 E Valley View Pkwy
Ste G
Independence, MO 64055-6910
Phone (816) 254-2552
Other practice location 1
19201 E Valley View Pkwy
Ste G
Independence, MO 64055-6910
Phone (816) 254-2552
Other providers in Waterbury, CT
- Richard T. Aust
- Authentic Recovery, LLC
- Nicole Aviles
- Briana Rose Avitable
- Brooj Awan
- Oluwadare Olanipekun Awolola
- Vanessa Asonyu Ayafor
- Shehmeer M Ayaz
- Rachel Aybar
- Adem Aydin
All providers in Waterbury, CT · Nurse Practitioner in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.