Provider Demographics
NPI:1790926343
Name:BASSEY, OLUWAFUNMILAYO OLUWADAMILOLA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:OLUWAFUNMILAYO
Middle Name:OLUWADAMILOLA
Last Name:BASSEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 BEACH 60TH ST
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1849
Mailing Address - Country:US
Mailing Address - Phone:347-230-4991
Mailing Address - Fax:
Practice Address - Street 1:316 BEACH 65TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11692-1425
Practice Address - Country:US
Practice Address - Phone:718-474-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY287276-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse