Provider Demographics
NPI:1366045031
Name:LAWAL, OLUWAGBEMIGA (RN)
Entity Type:Individual
Prefix:
First Name:OLUWAGBEMIGA
Middle Name:
Last Name:LAWAL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:GBENGA
Other - Middle Name:
Other - Last Name:LAWA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1022 REV JAMES A POLITE AVE APT 4A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-2781
Mailing Address - Country:US
Mailing Address - Phone:917-635-8536
Mailing Address - Fax:
Practice Address - Street 1:1022 REV JAMES A POLITE AVE APT 4A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-2781
Practice Address - Country:US
Practice Address - Phone:917-635-8536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY687667163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse