Provider Demographics
NPI:1770756264
Name:OLUWAFEMI, OLUSOLA GBENGA (LVN)
Entity type:Individual
Prefix:MR
First Name:OLUSOLA
Middle Name:GBENGA
Last Name:OLUWAFEMI
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 REDCLIFFE CT
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-3264
Mailing Address - Country:US
Mailing Address - Phone:916-612-2857
Mailing Address - Fax:
Practice Address - Street 1:400 REDCLIFFE CT
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-3264
Practice Address - Country:US
Practice Address - Phone:916-612-2857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN218499164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse