Provider Demographics
NPI:1376805507
Name:KING, SUKAINATU ADENIKLE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:SUKAINATU
Middle Name:ADENIKLE
Last Name:KING
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 WINDING WOOD DR
Mailing Address - Street 2:# 1B
Mailing Address - City:SAYREVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08872-2007
Mailing Address - Country:US
Mailing Address - Phone:732-763-8819
Mailing Address - Fax:
Practice Address - Street 1:46 WINDING WOOD DR
Practice Address - Street 2:# 1B
Practice Address - City:SAYREVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08872-2007
Practice Address - Country:US
Practice Address - Phone:732-763-8819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305648-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse