Provider Demographics
NPI:1912370495
Name:OLADIJO, MONSURAT (LPN NURSE)
Entity Type:Individual
Prefix:
First Name:MONSURAT
Middle Name:
Last Name:OLADIJO
Suffix:
Gender:F
Credentials:LPN NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 AVENUE H
Mailing Address - Street 2:APT 2L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-3354
Mailing Address - Country:US
Mailing Address - Phone:718-864-3531
Mailing Address - Fax:
Practice Address - Street 1:3320 AVENUE H
Practice Address - Street 2:APT 2L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-3354
Practice Address - Country:US
Practice Address - Phone:718-864-3531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY324221164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY324221OtherNCSBN