Provider Demographics
NPI:1104903574
Name:OGUNLANA, OGUNREMI (RN, MSN, PHN, FNP)
Entity type:Individual
Prefix:MS
First Name:OGUNREMI
Middle Name:
Last Name:OGUNLANA
Suffix:
Gender:F
Credentials:RN, MSN, PHN, FNP
Other - Prefix:
Other - First Name:REMI
Other - Middle Name:
Other - Last Name:OGUNLANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, MSN, PHN, FNP
Mailing Address - Street 1:PO BOX 1681
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-6681
Mailing Address - Country:US
Mailing Address - Phone:510-794-8538
Mailing Address - Fax:510-794-8538
Practice Address - Street 1:5428 PORT SAILWOOD DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560
Practice Address - Country:US
Practice Address - Phone:510-794-8538
Practice Address - Fax:510-794-8538
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2018-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA650782163W00000X
CA72319163WC1500X
CA17786363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health