Provider Demographics
NPI:1972730992
Name:SODE, OLUFEMI SAMUEL (RN)
Entity type:Individual
Prefix:
First Name:OLUFEMI
Middle Name:SAMUEL
Last Name:SODE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 763
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-0763
Mailing Address - Country:US
Mailing Address - Phone:856-278-2223
Mailing Address - Fax:
Practice Address - Street 1:521 SICKLERVILLE RD STE 2
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-2636
Practice Address - Country:US
Practice Address - Phone:866-867-5435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2024-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP05883700164W00000X
FLRN9583532163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No164W00000XNursing Service ProvidersLicensed Practical Nurse