Provider Demographics
NPI:1871737031
Name:OLABISI, OMOLARA AYOBAMI
Entity type:Individual
Prefix:MISS
First Name:OMOLARA
Middle Name:AYOBAMI
Last Name:OLABISI
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:OMOLARA
Other - Middle Name:AYOBAMI
Other - Last Name:AWODOYIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:2009 CHATTERTON AVE
Mailing Address - Street 2:PH
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-6105
Mailing Address - Country:US
Mailing Address - Phone:917-302-2598
Mailing Address - Fax:
Practice Address - Street 1:2009 CHATTERTON AVE
Practice Address - Street 2:PH
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-6105
Practice Address - Country:US
Practice Address - Phone:917-302-2598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY557818163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse