Provider Demographics
NPI:1215503354
Name:OLUWAGBAMILA, GERALDA BETTINA (MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:GERALDA
Middle Name:BETTINA
Last Name:OLUWAGBAMILA
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 PENNINGTON RD
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-2669
Mailing Address - Country:US
Mailing Address - Phone:609-890-1050
Mailing Address - Fax:609-890-0950
Practice Address - Street 1:1440 PENNINGTON RD
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-2669
Practice Address - Country:US
Practice Address - Phone:609-890-1050
Practice Address - Fax:609-890-0950
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-30
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01134600363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner