Healthcare Provider Details

I. General information

NPI: 1144525924
Provider Name (Legal Business Name): OMOLARA Y OKUNFOLAMI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2011
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 BREN RD E
MINNETONKA MN
55343-9664
US

IV. Provider business mailing address

34 BRIARBROOKE LN
CRANSTON RI
02921-2111
US

V. Phone/Fax

Practice location:
  • Phone: 401-408-3569
  • Fax:
Mailing address:
  • Phone: 401-286-6784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNPP37552
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: