Provider Demographics
NPI:1578834404
Name:KOLAWOLE, EUNICE AYOADE (RN)
Entity Type:Individual
Prefix:MS
First Name:EUNICE
Middle Name:AYOADE
Last Name:KOLAWOLE
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 1:423 BEACH 44TH ST
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-1221
Mailing Address - Country:US
Mailing Address - Phone:718-415-7794
Mailing Address - Fax:718-945-8870
Practice Address - Street 1:423 BEACH 44TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-1221
Practice Address - Country:US
Practice Address - Phone:718-415-7794
Practice Address - Fax:718-945-8870
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY608631163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse