Provider Demographics
NPI:1184859712
Name:AWOGBEMILA, OLUFOLAKE M
Entity Type:Individual
Prefix:
First Name:OLUFOLAKE
Middle Name:M
Last Name:AWOGBEMILA
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 1:5715 SHORE FRONT PKWY
Mailing Address - Street 2:APT 1604
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1840
Mailing Address - Country:US
Mailing Address - Phone:347-230-4267
Mailing Address - Fax:
Practice Address - Street 1:5715 SHORE FRONT PKWY
Practice Address - Street 2:APT 1604
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1840
Practice Address - Country:US
Practice Address - Phone:347-230-4267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291028164W00000X
NY649535-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse