Provider Demographics
NPI:1811587744
Name:OLATUNJI, NOMATHEMBI SHAKURA (DNP)
Entity Type:Individual
Prefix:
First Name:NOMATHEMBI
Middle Name:SHAKURA
Last Name:OLATUNJI
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9535 BIRCH RUN
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-8950
Mailing Address - Country:US
Mailing Address - Phone:248-225-2759
Mailing Address - Fax:
Practice Address - Street 1:9535 BIRCH RUN
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-8950
Practice Address - Country:US
Practice Address - Phone:248-225-2759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704209036163WG0600X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
No163WG0600XNursing Service ProvidersRegistered NurseGerontology