Provider Demographics
NPI:1275099202
Name:KELANI, BOLANLE AYINKE (RN FNP)
Entity Type:Individual
Prefix:
First Name:BOLANLE
Middle Name:AYINKE
Last Name:KELANI
Suffix:
Gender:F
Credentials:RN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 SOUTHLAND MALL
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-2150
Mailing Address - Country:US
Mailing Address - Phone:510-266-1742
Mailing Address - Fax:510-266-1740
Practice Address - Street 1:664 SOUTHLAND MALL
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-2150
Practice Address - Country:US
Practice Address - Phone:510-266-1742
Practice Address - Fax:510-266-1740
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA367616163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse