MEDICARE: IBUKUN OLUWATOSIN OJIFINNI ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	38524.1714	WY

General Provider Information

NPI Number	:	1316449275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IBUKUN OLUWATOSIN OJIFINNI ARNP

Provider Business Mailing Address
First Line	:	PO BOX 2148
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82902-2148
Country	:	US
Telephone Number	:	307-362-5116
Fax Number	:	307-362-5145

Provider Business Practice Location Address
First Line	:	2620 COMMERCIAL WAY STE 120
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-4746
Country	:	US
Telephone Number	:	307-362-5116
Fax Number	:	307-362-5145

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2018
Last Update Date	:	03/06/2018

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