Provider Demographics
NPI:1740514371
Name:OGUNWALE, OLUBUNMI OLANIPEKUN
Entity type:Individual
Prefix:MR
First Name:OLUBUNMI
Middle Name:OLANIPEKUN
Last Name:OGUNWALE
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:OLUBUNMI
Other - Middle Name:OLANIPEKUN
Other - Last Name:OGUNWALE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:12 EAST DR APT 2E
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-1139
Mailing Address - Country:US
Mailing Address - Phone:631-357-3911
Mailing Address - Fax:
Practice Address - Street 1:12 EAST DR APT 2E
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-1139
Practice Address - Country:US
Practice Address - Phone:631-357-3911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY611147-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse