| Pathway Virtu-health | |
|
4570 Churchill St Ste 140 Shoreview MN 55126-2274 | |
| (612) 517-1293 | |
| (612) 349-2790 |
| Full Name | Pathway Virtu-health |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 4570 Churchill St Ste 140, Shoreview, Minnesota |
| Authorized Official Name and Position | Temitope Abiola Dawodu (PROVIDER) |
| Authorized Official Contact | 6125171293 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pathway Virtu-health 4570 Churchill St Ste 140 Shoreview MN 55126-2274 Ph: (612) 517-1293 | Pathway Virtu-health 4570 Churchill St Ste 140 Shoreview MN 55126-2274 Ph: (612) 517-1293 |
| NPI Number | 1073134284 |
|---|---|
| Provider Enumeration Date | 04/28/2020 |
| Last Update Date | 01/20/2023 |
| Certification Date | 01/20/2023 |
| Medicare PECOS PAC ID | 0446671739 |
|---|---|
| Medicare Enrollment ID | O20200521001372 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073134284 | NPI | - | NPPES |
| Provider Name | Temitope A Dawodu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306296967 PECOS PAC ID: 6002109964 Enrollment ID: I20160729001155 |
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