Healthcare Provider Details

I. General information

NPI: 1194558817
Provider Name (Legal Business Name): NURSE NEIGHBOR RN NP FAMILY HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 FIRETHORNE LN
VALLEY STREAM NY
11581-1727
US

IV. Provider business mailing address

17 FIRETHORNE LN
VALLEY STREAM NY
11581-1727
US

V. Phone/Fax

Practice location:
  • Phone: 516-847-2418
  • Fax: 970-233-4556
Mailing address:
  • Phone: 516-847-2418
  • Fax: 970-233-4556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GRACE OLAMIJULO
Title or Position: CEO
Credential: NP
Phone: 516-847-2418