Provider Demographics
NPI:1821473208
Name:LAWAL, OLUSEYI (APN)
Entity Type:Individual
Prefix:
First Name:OLUSEYI
Middle Name:
Last Name:LAWAL
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HARMONY LN
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-3474
Mailing Address - Country:US
Mailing Address - Phone:908-922-5423
Mailing Address - Fax:
Practice Address - Street 1:25 HARMONY LN
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-3474
Practice Address - Country:US
Practice Address - Phone:908-922-5423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00579400363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner