Healthcare Provider Details

I. General information

NPI: 1023761236
Provider Name (Legal Business Name): CHRISTINE ERICALYNN OKUNDAYE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8525 EDINBROOK XING STE 5
BROOKLYN PARK MN
55443-1966
US

IV. Provider business mailing address

9239 TELFORD BAY
BROOKLYN PARK MN
55443-3863
US

V. Phone/Fax

Practice location:
  • Phone: 612-250-7935
  • Fax:
Mailing address:
  • Phone: 612-250-7935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2089676
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: