Provider Demographics
NPI:1497218606
Name:OLA, AYOMIDE (RN)
Entity Type:Individual
Prefix:
First Name:AYOMIDE
Middle Name:
Last Name:OLA
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 1:2160 CATON AVE APT 6F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-2563
Mailing Address - Country:US
Mailing Address - Phone:917-375-0638
Mailing Address - Fax:
Practice Address - Street 1:2160 CATON AVE APT 6F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-2563
Practice Address - Country:US
Practice Address - Phone:917-375-0638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-13
Last Update Date:2019-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY767284163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse