Provider Demographics
NPI:1790533354
Name:LAWAL, OLAYINKA STELLA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:OLAYINKA
Middle Name:STELLA
Last Name:LAWAL
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19502 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-4031
Mailing Address - Country:US
Mailing Address - Phone:718-464-4505
Mailing Address - Fax:
Practice Address - Street 1:19502 69TH AVE
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-4031
Practice Address - Country:US
Practice Address - Phone:718-464-4505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY505327163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool