Provider Demographics
NPI:1104114149
Name:AWE, OLUBUKOLA (NP)
Entity type:Individual
Prefix:
First Name:OLUBUKOLA
Middle Name:
Last Name:AWE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19201 E VALLEY VIEW PKWY
Mailing Address - Street 2:STE G
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6910
Mailing Address - Country:US
Mailing Address - Phone:816-254-2552
Mailing Address - Fax:816-833-4155
Practice Address - Street 1:140 GRANDVIEW AVE STE L01
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2500
Practice Address - Country:US
Practice Address - Phone:203-574-4187
Practice Address - Fax:203-575-2153
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011009356363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner