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NPI Code Detail

MEDICARE: OLUBUKOLA KOMOLAFE NURSE PRACTITIONER

MEDICARE: OLUBUKOLA KOMOLAFE NURSE PRACTITIONER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAP10975AZ
2363LP0808XPsychiatric/Mental Health Nurse PractitionerAP10975AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134628738
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLUBUKOLA KOMOLAFE NURSE PRACTITIONER
Provider Business Mailing Address
First Line : PO BOX 2251
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85252-2251
Country : US
Telephone Number : 832-542-3181
Fax Number :
Provider Business Practice Location Address
First Line : 13838 S 46TH PL STE 340
Second Line :
City : PHOENIX
State : AZ
Zip : 85044-7805
Country : US
Telephone Number : 832-542-3181
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2018
Last Update Date : 10/01/2021

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Directions to “ OLUBUKOLA KOMOLAFE NURSE PRACTITIONER” Practice Location

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