Provider Demographics
NPI:1740848738
Name:OGUNNAIKE, OLUFEMI (RN)
Entity type:Individual
Prefix:
First Name:OLUFEMI
Middle Name:
Last Name:OGUNNAIKE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3835 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-2533
Mailing Address - Country:US
Mailing Address - Phone:717-412-4154
Mailing Address - Fax:717-409-8635
Practice Address - Street 1:3835 WALNUT ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-2533
Practice Address - Country:US
Practice Address - Phone:717-412-4154
Practice Address - Fax:717-409-8635
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN643975163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102986580Medicaid