Individual
BOLANLE O ONIME
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2936 N ELM ST STE 102, LUMBERTON, NC 28358-2981
(910) 671-6619
(910) 608-0487
Mailing address
2936 N ELM ST STE 102, LUMBERTON, NC 28358-2981
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
219941
NC
363LF0000X
Family Nurse Practitioner
Primary
5011733
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30428812
DRIVER LICENSE
NC
Enumeration date
05/23/2019
Last updated
05/08/2023
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