Provider Demographics
NPI:1780222653
Name:AWOLOWO, FOLAKE MOTUNRAYO
Entity Type:Individual
Prefix:
First Name:FOLAKE
Middle Name:MOTUNRAYO
Last Name:AWOLOWO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FOLAKE
Other - Middle Name:MOTUNRAYO
Other - Last Name:ADEYEMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:456 RALPH AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-1832
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:456 RALPH AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-1832
Practice Address - Country:US
Practice Address - Phone:516-728-1912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336413164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse