MEDICARE: OLUKEMI OWOSENI NP

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
1	363LF0000X	Family Nurse Practitioner	26NJ00719600	NJ
2	363LF0000X	Family Nurse Practitioner	SP023523	PA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ00719600	NJ

Other Identifiers

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

General Provider Information

NPI Number	:	1205136215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUKEMI OWOSENI NP

Provider Business Mailing Address
First Line	:	192 WAVERLY DR
Second Line	:
City	:	EAST STROUDSBURG
State	:	PA
Zip	:	18302-9061
Country	:	US
Telephone Number	:	347-551-1187
Fax Number	:

Provider Business Practice Location Address
First Line	:	196 DWIGHT ST
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07305-3204
Country	:	US
Telephone Number	:	551-258-4422
Fax Number	:	551-214-0210

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2010
Last Update Date	:	09/28/2023

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