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General NPI Number Information
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NPI Number | 1669956579
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Entity Type | Individual
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Provider Name | ABIMBOLA VIVIAN OLANREWAJU FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/18/2018
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Last Update Date | 09/18/2018
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Provider Practice Location Address
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Address Line | 205 S ORANGE AVE
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City | NEWARK
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State | NJ
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Zip | 07103-2785
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Country | US
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Telephone | 973-972-1077
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Fax |
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Provider Business Mailing Address
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Address Line | 2710 VERONA AVE
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City | LINDEN
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State | NJ
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Zip | 07036-5121
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Country | US
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Telephone | 973-399-2848
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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 | 26NJ00834700
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License Number State | NJ
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