Provider Demographics
NPI:1174849814
Name:ASENUGA, OLAWANLE PRINCESS (RN)
Entity Type:Individual
Prefix:
First Name:OLAWANLE
Middle Name:PRINCESS
Last Name:ASENUGA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:OLAWANLE
Other - Middle Name:PRINCESS
Other - Last Name:BOONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:14440 184TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-3229
Mailing Address - Country:US
Mailing Address - Phone:917-499-1495
Mailing Address - Fax:718-712-1693
Practice Address - Street 1:14440 184TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-3229
Practice Address - Country:US
Practice Address - Phone:917-499-1495
Practice Address - Fax:718-712-1693
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY542068-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse