Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 95010385 | CA |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 95010385 | CA |
NPI | 1063980084 |
---|---|
Provider Name | Mrs. Dorothy Olere Okesola |
First Address | Santa Clarita, CA 91387-5423 |
Second Address | Santa Clarita, CA 91387 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2018 |
Last Update Date | 13/08/2019 |