Provider Demographics
NPI:1215725429
Name:OLONIBOKO, TUMININU GLADYS
Entity type:Individual
Prefix:
First Name:TUMININU
Middle Name:GLADYS
Last Name:OLONIBOKO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 HOLLY GROVE DR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-3202
Mailing Address - Country:US
Mailing Address - Phone:252-717-8898
Mailing Address - Fax:
Practice Address - Street 1:2607 MEDICAL OFFICE PL STE A
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9437
Practice Address - Country:US
Practice Address - Phone:919-739-9060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5021888363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily