Provider Demographics
NPI:1669892063
Name:FAFUNMI, FEMI BENJAMIN
Entity type:Individual
Prefix:
First Name:FEMI
Middle Name:BENJAMIN
Last Name:FAFUNMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10604 N COUNCIL RD APT 3
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-4318
Mailing Address - Country:US
Mailing Address - Phone:347-579-8416
Mailing Address - Fax:
Practice Address - Street 1:10604 N COUNCIL RD APT 3
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-4318
Practice Address - Country:US
Practice Address - Phone:347-579-8416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37H047950712376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide