Provider Demographics
NPI:1164869434
Name:OWOLODUN, OYEWALE OLA (LPN)
Entity Type:Individual
Prefix:MR
First Name:OYEWALE
Middle Name:OLA
Last Name:OWOLODUN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 RUTLAND RD APT 122
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-1510
Mailing Address - Country:US
Mailing Address - Phone:646-419-7402
Mailing Address - Fax:
Practice Address - Street 1:950 RUTLAND RD APT 122
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-1510
Practice Address - Country:US
Practice Address - Phone:646-419-7402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314528164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse