Provider Demographics
NPI:1346752839
Name:FATOLA, HANNAH OLUFADEKE (RN)
Entity Type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:OLUFADEKE
Last Name:FATOLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14703 115TH AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11436-1104
Mailing Address - Country:US
Mailing Address - Phone:347-276-8649
Mailing Address - Fax:718-845-5283
Practice Address - Street 1:14703 115TH AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11436-1104
Practice Address - Country:US
Practice Address - Phone:347-276-8649
Practice Address - Fax:718-845-5283
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY630166163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Single Specialty