Provider Demographics
NPI:1598076374
Name:AIDELOGIE, IFEOLUWA
Entity type:Individual
Prefix:
First Name:IFEOLUWA
Middle Name:
Last Name:AIDELOGIE
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 1:904 PINE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-5530
Mailing Address - Country:US
Mailing Address - Phone:718-484-2452
Mailing Address - Fax:
Practice Address - Street 1:904 PINE ST APT 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-5530
Practice Address - Country:US
Practice Address - Phone:718-484-2452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY555689163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool