Provider Demographics
NPI:1306419932
Name:OLUWAKOTANMI, STELLA OLUFUNKE (FNP)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:OLUFUNKE
Last Name:OLUWAKOTANMI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11007 VISTA DEL LUNA DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-9182
Mailing Address - Country:US
Mailing Address - Phone:623-852-1278
Mailing Address - Fax:
Practice Address - Street 1:11007 VISTA DEL LUNA DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-9182
Practice Address - Country:US
Practice Address - Phone:623-521-9727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021246363LF0000X
CA773915163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty