Healthcare Provider Details

I. General information

NPI: 1295044576
Provider Name (Legal Business Name): MOBOLAJI OYEKOLA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 S BROADWAY FL 2
YONKERS NY
10701-3708
US

IV. Provider business mailing address

41 CENTRE ST
YONKERS NY
10701-6525
US

V. Phone/Fax

Practice location:
  • Phone: 914-968-4898
  • Fax:
Mailing address:
  • Phone: 914-643-1149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number633555
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF342953-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: