Healthcare Provider Details

I. General information

NPI: 1720230204
Provider Name (Legal Business Name): ARIMOLA OKENLA KAKAMFO NURSE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 WEST ST
HYDE PARK MA
02136-1529
US

IV. Provider business mailing address

146 WEST ST
HYDE PARK MA
02136-1529
US

V. Phone/Fax

Practice location:
  • Phone: 617-230-9945
  • Fax: 760-888-9375
Mailing address:
  • Phone: 617-230-9945
  • Fax: 760-888-9375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License Number275042
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: