Provider Demographics
NPI:1316382674
Name:EKUNGBA, OLUWAFEMI KAMIL
Entity Type:Individual
Prefix:MR
First Name:OLUWAFEMI
Middle Name:KAMIL
Last Name:EKUNGBA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2437 PORTLAND ALY
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405
Mailing Address - Country:US
Mailing Address - Phone:541-937-5507
Mailing Address - Fax:
Practice Address - Street 1:2437 PORTLAND ALY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405
Practice Address - Country:US
Practice Address - Phone:541-937-5507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201330178LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse