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General NPI Number Information
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NPI Number | 1275059321
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Entity Type | Individual
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Provider Name | OMOLARA RACHAEL ADEDIJI RN, MSN, FNP
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Gender | Female
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Dates
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Enumeration Date | 08/21/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 210 TRANTOR PLACE APT 1D
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City | STATEN ISLAND
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State | NY
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Zip | 10302
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Country | US
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Telephone | 646-353-2238
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Fax |
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Provider Business Mailing Address
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Address Line | 210 TRANTOR PL APT 1D
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City | STATEN ISLAND
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State | NY
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Zip | 10302-1974
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Country | US
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Telephone | 646-353-2238
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 340336
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License Number State | NY
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