Provider Demographics
NPI:1124264213
Name:ALAO, ABOSEDE NIHINLOLA (RN, BSN , MSN)
Entity type:Individual
Prefix:MRS
First Name:ABOSEDE
Middle Name:NIHINLOLA
Last Name:ALAO
Suffix:
Gender:F
Credentials:RN, BSN , MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4589 STONELEDGE LN
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-2375
Mailing Address - Country:US
Mailing Address - Phone:315-412-3023
Mailing Address - Fax:
Practice Address - Street 1:4589 STONELEDGE LN
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-2375
Practice Address - Country:US
Practice Address - Phone:315-412-3023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-19
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY489569-1163WH0200X
NYF401309-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1124264213Medicaid