Provider Demographics
NPI:1750109971
Name:OKUWOBI, BUKUNOLA (PSYCHIATRIC NURSE PR)
Entity type:Individual
Prefix:
First Name:BUKUNOLA
Middle Name:
Last Name:OKUWOBI
Suffix:
Gender:F
Credentials:PSYCHIATRIC NURSE PR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2094 PITKIN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-3509
Mailing Address - Country:US
Mailing Address - Phone:718-240-0605
Mailing Address - Fax:718-240-0601
Practice Address - Street 1:2094 PITKIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-3509
Practice Address - Country:US
Practice Address - Phone:718-240-4000
Practice Address - Fax:718-240-0601
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF406349-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health