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General NPI Number Information
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NPI Number | 1104114149
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Entity Type | Individual
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Provider Name | OLUBUKOLA AWE NP
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Gender | Female
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Dates
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Enumeration Date | 07/12/2011
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 140 GRANDVIEW AVE STE L01
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City | WATERBURY
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State | CT
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Zip | 06708-2500
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Country | US
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Telephone | 203-574-4187
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Fax | 203-575-2153
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Provider Business Mailing Address
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Address Line | 19201 E VALLEY VIEW PKWY STE G
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City | INDEPENDENCE
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State | MO
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Zip | 64055-6910
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Country | US
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Telephone | 816-254-2552
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Fax | 816-833-4155
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2011009356
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License Number State | MO
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