Provider Demographics
NPI:1669706222
Name:OGUNWALE-LAOSEBIKAN, ABOSEDE T (RN)
Entity type:Individual
Prefix:
First Name:ABOSEDE
Middle Name:T
Last Name:OGUNWALE-LAOSEBIKAN
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 1:12 EAST DR
Mailing Address - Street 2:APT 2E
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-1171
Mailing Address - Country:US
Mailing Address - Phone:631-882-7541
Mailing Address - Fax:
Practice Address - Street 1:12 EAST DR
Practice Address - Street 2:APT 2E
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-1171
Practice Address - Country:US
Practice Address - Phone:631-882-7541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY595278-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse