Provider Demographics
NPI:1164889978
Name:OKUNOYE, MERVELLIN (RN BSN)
Entity Type:Individual
Prefix:
First Name:MERVELLIN
Middle Name:
Last Name:OKUNOYE
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 TOWNSEND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-3713
Mailing Address - Country:US
Mailing Address - Phone:347-228-3140
Mailing Address - Fax:718-876-0390
Practice Address - Street 1:91 TOWNSEND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304
Practice Address - Country:US
Practice Address - Phone:347-228-3140
Practice Address - Fax:718-876-0390
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY625894163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse