Provider Demographics
NPI:1134545353
Name:OLOWOYO, ADETINUKE
Entity type:Individual
Prefix:
First Name:ADETINUKE
Middle Name:
Last Name:OLOWOYO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18403 HENDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-3130
Mailing Address - Country:US
Mailing Address - Phone:718-300-2228
Mailing Address - Fax:
Practice Address - Street 1:18403 HENDERSON AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-3130
Practice Address - Country:US
Practice Address - Phone:718-300-2228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY670179163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse