Healthcare Provider Details

I. General information

NPI: 1316813959
Provider Name (Legal Business Name): JENNIFER OLADOKUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 10/24/2025
Certification Date: 10/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 SUNSET AVE
RIVERSIDE RI
02915-3610
US

IV. Provider business mailing address

23 SUNSET AVE
RIVERSIDE RI
02915-3610
US

V. Phone/Fax

Practice location:
  • Phone: 401-489-2199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN10031861
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: