Provider Demographics
NPI:1720559040
Name:OMOTOSHO, MORENIKE CHRISTIANAH (DOULA)
Entity Type:Individual
Prefix:
First Name:MORENIKE
Middle Name:CHRISTIANAH
Last Name:OMOTOSHO
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17404 140TH AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-4600
Mailing Address - Country:US
Mailing Address - Phone:347-869-4708
Mailing Address - Fax:
Practice Address - Street 1:17404 140TH AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-4600
Practice Address - Country:US
Practice Address - Phone:347-869-4708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-14
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY868374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula