Provider Demographics
NPI:1700142445
Name:ILORI, OLUFUNMILAYO O (APN)
Entity type:Individual
Prefix:MRS
First Name:OLUFUNMILAYO
Middle Name:O
Last Name:ILORI
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 GALLOPING HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083
Mailing Address - Country:US
Mailing Address - Phone:908-598-6655
Mailing Address - Fax:908-686-8374
Practice Address - Street 1:1000 GALLOPING HILL ROAD
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083
Practice Address - Country:US
Practice Address - Phone:908-598-6655
Practice Address - Fax:908-686-8374
Is Sole Proprietor?:No
Enumeration Date:2012-04-06
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00355200363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1427320357OtherORRGANIZATION