Provider Demographics
NPI:1023761236
Name:OKUNDAYE, CHRISTINE ERICALYNN (RN)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ERICALYNN
Last Name:OKUNDAYE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9239 TELFORD BAY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-3863
Mailing Address - Country:US
Mailing Address - Phone:612-250-7935
Mailing Address - Fax:
Practice Address - Street 1:8525 EDINBROOK XING STE 5
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-1966
Practice Address - Country:US
Practice Address - Phone:612-250-7935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2089676163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse