=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306419932
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STELLA OLUFUNKE OLUWAKOTANMI FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2021
-----------------------------------------------------
Last Update Date | 07/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11007 VISTA DEL LUNA DR
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93311-9182
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-521-9727
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11007 VISTA DEL LUNA DR
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93311-9182
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-852-1278
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 95021246
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------