Provider Demographics
NPI:1235021338
Name:OLUBAMBI, ELIZABETH ADEBISI (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ADEBISI
Last Name:OLUBAMBI
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-1933
Mailing Address - Country:US
Mailing Address - Phone:617-623-5277
Mailing Address - Fax:617-844-1352
Practice Address - Street 1:16 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-1933
Practice Address - Country:US
Practice Address - Phone:617-623-5277
Practice Address - Fax:617-844-1352
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-15
Last Update Date:2025-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2383085163WG0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice