Provider Demographics
NPI:1508278540
Name:ADEMOKUN, FUNMILOLA FUNKE
Entity Type:Individual
Prefix:
First Name:FUNMILOLA
Middle Name:FUNKE
Last Name:ADEMOKUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 FIELDMERE ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2007
Mailing Address - Country:US
Mailing Address - Phone:718-496-1196
Mailing Address - Fax:516-502-4313
Practice Address - Street 1:136 FIELDMERE ST
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-2007
Practice Address - Country:US
Practice Address - Phone:718-496-1196
Practice Address - Fax:516-502-4313
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-26
Last Update Date:2014-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317591164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse