Provider Demographics
NPI:1780010611
Name:OLOKUNBORO, ADESOLA C (RN)
Entity Type:Individual
Prefix:
First Name:ADESOLA
Middle Name:C
Last Name:OLOKUNBORO
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 1:358 DOHERTY AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3050
Mailing Address - Country:US
Mailing Address - Phone:516-424-8422
Mailing Address - Fax:
Practice Address - Street 1:358 DOHERTY AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-3050
Practice Address - Country:US
Practice Address - Phone:516-424-8422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY436657163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse