Provider Demographics
NPI:1649568833
Name:TIJANI- FALETI, WEMIMO (RN)
Entity Type:Individual
Prefix:MS
First Name:WEMIMO
Middle Name:
Last Name:TIJANI- FALETI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:WEMIMO
Other - Middle Name:
Other - Last Name:TIJANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:14380 231ST ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-3663
Mailing Address - Country:US
Mailing Address - Phone:718-415-7653
Mailing Address - Fax:
Practice Address - Street 1:14380 231ST ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-3663
Practice Address - Country:US
Practice Address - Phone:718-415-7653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY639184163W00000X, 163WG0000X
NY295403163WH0200X, 164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse