Provider Demographics
NPI:1427384445
Name:OSUMA, OLUWAKEMISOLA AYOKANMI (LPN)
Entity Type:Individual
Prefix:MS
First Name:OLUWAKEMISOLA
Middle Name:AYOKANMI
Last Name:OSUMA
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 1:133 SPARTAN AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-1893
Mailing Address - Country:US
Mailing Address - Phone:718-979-6900
Mailing Address - Fax:718-979-6940
Practice Address - Street 1:133 SPARTAN AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-1750
Practice Address - Country:US
Practice Address - Phone:973-417-5624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297224164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse