Provider Demographics
NPI:1750552931
Name:AIFESEHI, OLUBUSAYO (APN-C, DNP)
Entity type:Individual
Prefix:DR
First Name:OLUBUSAYO
Middle Name:
Last Name:AIFESEHI
Suffix:
Gender:F
Credentials:APN-C, DNP
Other - Prefix:DR
Other - First Name:OLUBUSAYO
Other - Middle Name:
Other - Last Name:REMI-JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP, DNP
Mailing Address - Street 1:15 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2961
Mailing Address - Country:US
Mailing Address - Phone:973-715-8871
Mailing Address - Fax:
Practice Address - Street 1:1701 W SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5646
Practice Address - Country:US
Practice Address - Phone:973-715-8871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020246363LP0808X
NJ26NR11286600363LF0000X
MDR198893363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ139068XVAMedicare UPIN