Healthcare Provider Details

I. General information

NPI: 1851142871
Provider Name (Legal Business Name): FAITH ONAJITE OKUNEYE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11033 UNIVERSITY AVE NE APT D
BLAINE MN
55434-1997
US

IV. Provider business mailing address

11033 UNIVERSITY AVE NE APT D
BLAINE MN
55434-1997
US

V. Phone/Fax

Practice location:
  • Phone: 763-310-6512
  • Fax:
Mailing address:
  • Phone: 763-310-6512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2521929
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: