Basic Information
| Provider Information | |||||||||
| NPI: | 1700142445 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ILORI | ||||||||
| FirstName: | OLUFUNMILAYO | ||||||||
| MiddleName: | O. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 GALLOPING HILL ROAD | ||||||||
| Address2: | |||||||||
| City: | UNION | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9085986655 | ||||||||
| FaxNumber: | 9086868374 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 GALLOPING HILL ROAD | ||||||||
| Address2: | |||||||||
| City: | UNION | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9085986655 | ||||||||
| FaxNumber: | 9086868374 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2012 | ||||||||
| LastUpdateDate: | 10/11/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 26NJ00355200 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1427320357 | 01 | NJ | ORRGANIZATION | OTHER |