Provider Demographics
NPI:1417340191
Name:AJAYI-OTUKOYA, IYINOLA OLUWAYEMISI (RN)
Entity Type:Individual
Prefix:MRS
First Name:IYINOLA
Middle Name:OLUWAYEMISI
Last Name:AJAYI-OTUKOYA
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 1:82 LUDLAM AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2109
Mailing Address - Country:US
Mailing Address - Phone:718-802-8512
Mailing Address - Fax:
Practice Address - Street 1:82 LUDLAM AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-2109
Practice Address - Country:US
Practice Address - Phone:718-802-8512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY457593-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse