Provider Demographics
NPI:1275136178
Name:SANNI, OLAYEMI OLAYINKA (DNP)
Entity Type:Individual
Prefix:DR
First Name:OLAYEMI
Middle Name:OLAYINKA
Last Name:SANNI
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:DR
Other - First Name:OLAYEMI
Other - Middle Name:OLAYINKA
Other - Last Name:SANNI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP
Mailing Address - Street 1:6062 ANNE DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3138
Mailing Address - Country:US
Mailing Address - Phone:248-895-7028
Mailing Address - Fax:
Practice Address - Street 1:6062 ANNE DR
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3138
Practice Address - Country:US
Practice Address - Phone:248-895-7028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704279939363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704279939OtherBOARD OF NURSING