Provider Demographics
NPI:1477006302
Name:OKUNOREN-SONUBI, ABIMBOLA (FNP)
Entity Type:Individual
Prefix:
First Name:ABIMBOLA
Middle Name:
Last Name:OKUNOREN-SONUBI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1276 FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-3402
Mailing Address - Country:US
Mailing Address - Phone:718-901-8862
Mailing Address - Fax:
Practice Address - Street 1:1276 FULTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3402
Practice Address - Country:US
Practice Address - Phone:718-901-8862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY586053163W00000X
NYF340481-1364SF0001X
NY340481363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
WI331009Medicare Oscar/Certification
WI331043Medicare Oscar/Certification
WI331947Medicare Oscar/Certification
WI331058Medicare Oscar/Certification
WI331943Medicare Oscar/Certification
WI331954Medicare Oscar/Certification
NYW6L111Medicare Oscar/Certification
WI331978Medicare Oscar/Certification
WI331952Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification
WI331946Medicare Oscar/Certification
WI331944Medicare Oscar/Certification
WI331945Medicare Oscar/Certification