Provider Demographics
NPI:1245870831
Name:AWOLOWO, RACHEL R (NP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:R
Last Name:AWOLOWO
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:PO BOX 515
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-0515
Mailing Address - Country:US
Mailing Address - Phone:718-314-6350
Mailing Address - Fax:
Practice Address - Street 1:2386 MORRIS AVE STE 107-109
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5723
Practice Address - Country:US
Practice Address - Phone:718-314-6350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402770363LP0808X
NJ26NJ00991500363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health