Provider Demographics
NPI:1568298040
Name:AWOLU, MARDIYA SUHIYINI
Entity type:Individual
Prefix:
First Name:MARDIYA
Middle Name:SUHIYINI
Last Name:AWOLU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 MARSHALL ST APT 7B
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-8713
Mailing Address - Country:US
Mailing Address - Phone:973-517-3359
Mailing Address - Fax:
Practice Address - Street 1:14 MARSHALL ST APT 7B
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-8713
Practice Address - Country:US
Practice Address - Phone:973-517-3359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR20330400163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse