Provider Demographics
NPI:1922268291
Name:SOWOLE, OLUFUNMILAYO O (LPN)
Entity Type:Individual
Prefix:MRS
First Name:OLUFUNMILAYO
Middle Name:O
Last Name:SOWOLE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:OLUFUNMILAYO
Other - Middle Name:O
Other - Last Name:SOLOMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:316 BEACH 65TH ST
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1425
Mailing Address - Country:US
Mailing Address - Phone:718-474-3800
Mailing Address - Fax:718-318-6372
Practice Address - Street 1:316 BEACH 65TH ST
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1425
Practice Address - Country:US
Practice Address - Phone:718-474-3800
Practice Address - Fax:718-318-6372
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2835751164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse