Provider Demographics
NPI:1144543315
Name:SOETAN, OLUYEMISI RAFIAT
Entity type:Individual
Prefix:
First Name:OLUYEMISI
Middle Name:RAFIAT
Last Name:SOETAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 SUMNER AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07062-1532
Mailing Address - Country:US
Mailing Address - Phone:973-493-6606
Mailing Address - Fax:
Practice Address - Street 1:133 SUMNER AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07062-1532
Practice Address - Country:US
Practice Address - Phone:973-493-6606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254299-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse