Provider Demographics
NPI:1093468209
Name:OGUNRUKU, FUNMILAYO A (APN)
Entity Type:Individual
Prefix:
First Name:FUNMILAYO
Middle Name:A
Last Name:OGUNRUKU
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CYPRESS ST APT 3
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07108-3750
Mailing Address - Country:US
Mailing Address - Phone:609-892-1358
Mailing Address - Fax:
Practice Address - Street 1:50 CYPRESS ST APT 3
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07108-3750
Practice Address - Country:US
Practice Address - Phone:609-892-1358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ000000163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ00000OtherN/A