Provider Demographics
NPI:1093066573
Name:KANMI, OLAMIDE OLAWALE
Entity Type:Individual
Prefix:
First Name:OLAMIDE
Middle Name:OLAWALE
Last Name:KANMI
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 1:1800 EAST 54 ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4607
Mailing Address - Country:US
Mailing Address - Phone:347-446-6995
Mailing Address - Fax:
Practice Address - Street 1:1800 E 54TH ST
Practice Address - Street 2:1800 EAST 54 ST
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4607
Practice Address - Country:US
Practice Address - Phone:347-446-6995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide