Provider Demographics
NPI:1780831156
Name:OGUNDOKUN, BOLANLE ADENIKE (RN)
Entity Type:Individual
Prefix:MISS
First Name:BOLANLE
Middle Name:ADENIKE
Last Name:OGUNDOKUN
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 1:8825 163RD STREET
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432
Mailing Address - Country:US
Mailing Address - Phone:718-739-0045
Mailing Address - Fax:718-739-0102
Practice Address - Street 1:8825 163RD STREET
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432
Practice Address - Country:US
Practice Address - Phone:718-739-0045
Practice Address - Fax:718-739-0102
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY690496163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse