Provider Demographics
NPI:1598579096
Name:OLANIYAN, GLORY I
Entity type:Individual
Prefix:
First Name:GLORY
Middle Name:I
Last Name:OLANIYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GLORY
Other - Middle Name:I
Other - Last Name:IKEATA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:975 106TH LANE NW
Mailing Address - Street 2:APT 62
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433
Mailing Address - Country:US
Mailing Address - Phone:651-757-8575
Mailing Address - Fax:
Practice Address - Street 1:975 106TH LANE NW
Practice Address - Street 2:APT 62
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433
Practice Address - Country:US
Practice Address - Phone:651-757-8575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide