Olubowale Fasola, LPN
Licensed Practical Nurse in Mount Vernon, NY. Individual provider (NPI-1).
NPI number1851648596
StatusActive
Last updated in NPPESJul 2, 2015
Details
- NPI
- 1851648596
- Entity type
- Individual (NPI-1)
- Name
- Olubowale Fasola
- Credential
- LPN
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Aug 13, 2012
- Last updated
- Jul 2, 2015
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 164W00000X | Licensed Practical Nurse | 299582 | NY | Yes |
Practice location
9 W Prospect Ave Ste 310Mount Vernon, NY 10550-2049
Phone 914-699-0022
Mailing address
9 W Prospect Ave Ste 310Mount Vernon, NY 10550-2049
Phone 914-699-0022
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 180 Licensed Practical Nurse providers in Mount Vernon · All 1,595 providers in Mount Vernon
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