Provider Demographics
NPI:1205136215
Name:OWOSENI, OLUKEMI (NP)
Entity type:Individual
Prefix:
First Name:OLUKEMI
Middle Name:
Last Name:OWOSENI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 WAVERLY DR
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18302-9061
Mailing Address - Country:US
Mailing Address - Phone:347-551-1187
Mailing Address - Fax:
Practice Address - Street 1:196 DWIGHT ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-3204
Practice Address - Country:US
Practice Address - Phone:551-258-4422
Practice Address - Fax:551-214-0210
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00719600363LF0000X, 363LP0808X
PASP023523363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0562521Medicaid