Provider Demographics
NPI:1457637076
Name:OKUNROBO, FAITH (LPN)
Entity Type:Individual
Prefix:MS
First Name:FAITH
Middle Name:
Last Name:OKUNROBO
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 1:881 FAIRMOUNT PL
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-4256
Mailing Address - Country:US
Mailing Address - Phone:718-617-4052
Mailing Address - Fax:718-617-4052
Practice Address - Street 1:881 FAIRMOUNT PLACE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-4256
Practice Address - Country:US
Practice Address - Phone:718-617-4052
Practice Address - Fax:718-617-4052
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307600164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse