Provider Demographics
NPI:1013275072
Name:OYEBOLA, TOLULOPE KIKELOMO (LPN)
Entity type:Individual
Prefix:MISS
First Name:TOLULOPE
Middle Name:KIKELOMO
Last Name:OYEBOLA
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 1:852 E 213TH ST
Mailing Address - Street 2:APT. 3F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-5970
Mailing Address - Country:US
Mailing Address - Phone:347-755-3796
Mailing Address - Fax:
Practice Address - Street 1:852 E 213TH ST
Practice Address - Street 2:APT. 3F
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-5970
Practice Address - Country:US
Practice Address - Phone:347-755-3796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309705-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse