Provider Demographics
NPI:1063980084
Name:OKESOLA, DOROTHY OLERE (FNP)
Entity type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:OLERE
Last Name:OKESOLA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:DOROTHY
Other - Middle Name:OLERE
Other - Last Name:KEMIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:18333 DOLAN WAY STE 206
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91387-5423
Mailing Address - Country:US
Mailing Address - Phone:661-424-9590
Mailing Address - Fax:661-424-9590
Practice Address - Street 1:18333 DOLAN WAY STE 206
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91387
Practice Address - Country:US
Practice Address - Phone:661-424-9590
Practice Address - Fax:661-424-9591
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA549002163WC1500X
CA771407163WH0200X
CA95010385363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily