Individual
MR. OLUMIDE ISAAC FAMOJURO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
83 VAN BUREN ST, FREEPORT, NY 11520-6226
(347) 837-9177
Mailing address
83 VAN BUREN ST, FREEPORT, NY 11520-6226
(347) 837-9177
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
661135
NY
367500000X
Certified Registered Nurse Anesthetist
Primary
133988
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
132400594
DRIVERS LICENSE
NY
Enumeration date
02/22/2019
Last updated
01/15/2021
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