Provider Demographics
NPI:1376880625
Name:OLUYEMI, BASSEY KUBIANGHA (R N)
Entity Type:Individual
Prefix:
First Name:BASSEY
Middle Name:KUBIANGHA
Last Name:OLUYEMI
Suffix:
Gender:F
Credentials:R N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 HOLLAND AVE
Mailing Address - Street 2:APT. 11D
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-1219
Mailing Address - Country:US
Mailing Address - Phone:347-857-5698
Mailing Address - Fax:
Practice Address - Street 1:35 HOLLAND AVE
Practice Address - Street 2:APT. 11D
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-1219
Practice Address - Country:US
Practice Address - Phone:347-857-5698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY656031163W00000X, 171W00000X, 251E00000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No171W00000XOther Service ProvidersContractor
No251E00000XAgenciesHome Health
No372600000XNursing Service Related ProvidersAdult Companion