Healthcare Provider Details

I. General information

NPI: 1205136215
Provider Name (Legal Business Name): OLUKEMI OWOSENI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 DWIGHT ST
JERSEY CITY NJ
07305-3204
US

IV. Provider business mailing address

192 WAVERLY DR
EAST STROUDSBURG PA
18302-9061
US

V. Phone/Fax

Practice location:
  • Phone: 551-258-4422
  • Fax: 551-214-0210
Mailing address:
  • Phone: 347-551-1187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00719600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP023523
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00719600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: