Provider Demographics
NPI:1912151085
Name:OLOSUNDE, MICHAEL O (LPN)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:O
Last Name:OLOSUNDE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 FULTON ST
Mailing Address - Street 2:APT 22
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-8201
Mailing Address - Country:US
Mailing Address - Phone:347-515-8552
Mailing Address - Fax:
Practice Address - Street 1:950 FULTON ST
Practice Address - Street 2:APT 22
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-8201
Practice Address - Country:US
Practice Address - Phone:347-515-8552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-15
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288166-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse