Provider Demographics
NPI:1134574924
Name:BAKARE, ONAJOMO VIOLET (NP)
Entity type:Individual
Prefix:MRS
First Name:ONAJOMO
Middle Name:VIOLET
Last Name:BAKARE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:ONAJOMO
Other - Middle Name:VIOLET
Other - Last Name:BAKARE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:21865 WINCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4829
Mailing Address - Country:US
Mailing Address - Phone:313-989-5358
Mailing Address - Fax:
Practice Address - Street 1:21865 WINCHESTER ST
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-4829
Practice Address - Country:US
Practice Address - Phone:313-989-5358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704251975363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily