Provider Demographics
NPI:1235489063
Name:OLUFEMI, OLATUNDE AJANI (LPN)
Entity Type:Individual
Prefix:MR
First Name:OLATUNDE
Middle Name:AJANI
Last Name:OLUFEMI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 N ELLIOTT PL
Mailing Address - Street 2:APT. 3G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-1044
Mailing Address - Country:US
Mailing Address - Phone:917-657-5519
Mailing Address - Fax:
Practice Address - Street 1:55 N ELLIOTT PL
Practice Address - Street 2:APT. 3G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-1044
Practice Address - Country:US
Practice Address - Phone:917-657-5519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310978-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse