Provider Demographics
NPI:1275116584
Name:OGUNWUSI, KEMI FUNLAYO (FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:KEMI
Middle Name:FUNLAYO
Last Name:OGUNWUSI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-4148
Mailing Address - Country:US
Mailing Address - Phone:302-744-8438
Mailing Address - Fax:302-744-8425
Practice Address - Street 1:888 SOUTH STATE STREET
Practice Address - Street 2:N/A
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4148
Practice Address - Country:US
Practice Address - Phone:302-385-1988
Practice Address - Fax:302-387-1170
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2024-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0042039363LF0000X, 363LP2300X
DELG-0011654363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty