Provider Demographics
NPI:1124319413
Name:KELANI, KABIR OLAYIWOLA (LPN)
Entity type:Individual
Prefix:
First Name:KABIR
Middle Name:OLAYIWOLA
Last Name:KELANI
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 1:204 VALLEY STREAM DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702
Mailing Address - Country:US
Mailing Address - Phone:302-743-5131
Mailing Address - Fax:267-292-2657
Practice Address - Street 1:204 VALLEY STREAM DRIVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702
Practice Address - Country:US
Practice Address - Phone:302-743-5131
Practice Address - Fax:267-292-2657
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PALP284002164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse