Healthcare Provider Details

I. General information

NPI: 1306158340
Provider Name (Legal Business Name): OLUWASEYI OWOSENI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13028 223RD ST
LAURELTON NY
11413-1242
US

IV. Provider business mailing address

13028 223RD ST
LAURELTON NY
11413-1242
US

V. Phone/Fax

Practice location:
  • Phone: 347-869-7722
  • Fax:
Mailing address:
  • Phone: 347-869-7722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number5800071
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: