Individual
ADEWUNMI JULIUS BANKOLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
261 MERRYMOUNT ST, STATEN ISLAND, NY 10314-4850
(347) 855-1908
Mailing address
261 MERRYMOUNT ST, STATEN ISLAND, NY 10314-4850
(347) 855-1908
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
710835
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
26NJ01131600
NJ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
F403449
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0899062
—
NJ
Enumeration date
08/31/2016
Last updated
04/03/2023
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