Provider Demographics
NPI:1144653502
Name:BELLO, OLAYEMI AWOSANYA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:OLAYEMI
Middle Name:AWOSANYA
Last Name:BELLO
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 DANIEL PARK RUN
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7823
Mailing Address - Country:US
Mailing Address - Phone:920-268-5215
Mailing Address - Fax:
Practice Address - Street 1:125 KING AVE STE 200
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6710
Practice Address - Country:US
Practice Address - Phone:706-369-4478
Practice Address - Fax:706-353-6639
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN266075363L00000X
WI15955363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1144653502Medicaid