Healthcare Provider Details

I. General information

NPI: 1225962293
Provider Name (Legal Business Name): DAMILOLA EUNICE FENWA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 THOREAU TER
UNION NJ
07083-7829
US

IV. Provider business mailing address

501 THOREAU TER
UNION NJ
07083-7829
US

V. Phone/Fax

Practice location:
  • Phone: 862-224-0308
  • Fax: 862-224-0308
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026024500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: