Healthcare Provider Details

I. General information

NPI: 1346643657
Provider Name (Legal Business Name): OLUKEMI FLORENCE OKUNLOLA DNP, MHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 WINTHROP ST
BROOKLYN NY
11212-1483
US

IV. Provider business mailing address

1040 WINTHROP ST
BROOKLYN NY
11212-1483
US

V. Phone/Fax

Practice location:
  • Phone: 718-363-3040
  • Fax: 718-363-3040
Mailing address:
  • Phone: 718-363-3040
  • Fax: 718-363-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF401794
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: