MEDICARE: OLUFEMI OGUNNAIKE RN

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	163W00000X	Registered Nurse	RN643975	PA

General Provider Information

NPI Number	:	1740848738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUFEMI OGUNNAIKE RN

Provider Business Mailing Address
First Line	:	3835 WALNUT ST
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17109-2533
Country	:	US
Telephone Number	:	717-412-4154
Fax Number	:	717-409-8635

Provider Business Practice Location Address
First Line	:	3835 WALNUT ST
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17109-2533
Country	:	US
Telephone Number	:	717-412-4154
Fax Number	:	717-409-8635

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

Provider Enumeration Date	:	06/04/2019
Last Update Date	:	07/12/2022

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