Organization
LIFE SPAN WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABIODUN OLATUBOSUN NP (NURSE PRACTITIONER, PSYCH)
(551) 275-5674
Entity
Organization
Contact information
Practice address
156 BALDWIN PL, BLOOMFIELD, NJ 07003-6036
(551) 275-5674
Mailing address
156 BALDWIN PL, BLOOMFIELD, NJ 07003-6036
(551) 275-5674
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
04/05/2023
Last updated
04/05/2023
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