Provider Demographics
NPI:1811649536
Name:OLANIYAN, OLAYIDE (AG-ACNP-BC)
Entity type:Individual
Prefix:
First Name:OLAYIDE
Middle Name:
Last Name:OLANIYAN
Suffix:
Gender:F
Credentials:AG-ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 COUNTRY MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-6568
Mailing Address - Country:US
Mailing Address - Phone:908-463-3092
Mailing Address - Fax:
Practice Address - Street 1:4125 COUNTRY MEADOW LN
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-6568
Practice Address - Country:US
Practice Address - Phone:908-463-3092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024928363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care