Healthcare Provider Details

I. General information

NPI: 1104903574
Provider Name (Legal Business Name): OGUNREMI OGUNLANA RN, MSN, PHN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REMI OGUNLANA RN, MSN, PHN, FNP

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5428 PORT SAILWOOD DR
NEWARK CA
94560
US

IV. Provider business mailing address

PO BOX 1681
NEWARK CA
94560-6681
US

V. Phone/Fax

Practice location:
  • Phone: 510-794-8538
  • Fax: 510-794-8538
Mailing address:
  • Phone: 510-794-8538
  • Fax: 510-794-8538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number650782
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number72319
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17786
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: