Provider Demographics
NPI:1083151302
Name:OLUKANNI, NURAT OLAMITAN (RN)
Entity type:Individual
Prefix:MRS
First Name:NURAT
Middle Name:OLAMITAN
Last Name:OLUKANNI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:NURAT
Other - Middle Name:
Other - Last Name:OLUKANNI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:7557 BRENTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-2104
Mailing Address - Country:US
Mailing Address - Phone:215-779-6579
Mailing Address - Fax:
Practice Address - Street 1:133 HEATHER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3009
Practice Address - Country:US
Practice Address - Phone:484-278-4805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN613580163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health