Provider Demographics
NPI:1548553464
Name:ADEOLU, OLUWAMUYIWA BUSOLA (NURSING)
Entity type:Individual
Prefix:MRS
First Name:OLUWAMUYIWA
Middle Name:BUSOLA
Last Name:ADEOLU
Suffix:
Gender:F
Credentials:NURSING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 PARK HILL AVE APT 2W
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4740
Mailing Address - Country:US
Mailing Address - Phone:718-801-9175
Mailing Address - Fax:718-370-3145
Practice Address - Street 1:225 PARKHILL AVE
Practice Address - Street 2:APT 2W
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304
Practice Address - Country:US
Practice Address - Phone:718-801-9175
Practice Address - Fax:718-370-3145
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303884-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse