Healthcare Provider Details

I. General information

NPI: 1750109971
Provider Name (Legal Business Name): BUKUNOLA OKUWOBI PSYCHIATRIC NURSE PR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2094 PITKIN AVE
BROOKLYN NY
11207-3509
US

IV. Provider business mailing address

2094 PITKIN AVE
BROOKLYN NY
11207-3509
US

V. Phone/Fax

Practice location:
  • Phone: 718-240-4000
  • Fax: 718-240-0601
Mailing address:
  • Phone: 718-240-0605
  • Fax: 718-240-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF406349-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: