Active NPI
Olufemi Okuneye
- Family Nurse Practitioner
- Maple Grove, MN
National Provider Identifier
1366981649
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- CNP-4949
- Practice address
- 6300 Wedgewood Rd N
Maple Grove, MN 55311-3647 - Phone
- (763) 551-1215
- NPI assigned
- Feb 20, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | CNP-4949 | MN | Primary |
Addresses
Primary practice location
6300 Wedgewood Rd N
Maple Grove, MN 55311-3647
Mailing address
7628 Zane Ave N
Brooklyn Park, MN 55443-3151
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CNP-4949 | MN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grand St Paul CVS LLC | Past | Accepting new patients | |
| Grand St Paul CVS LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1487548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1487548800000",
"number": "1366981649",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7628 ZANE AVE N",
"city": "BROOKLYN PARK",
"state": "MN",
"postal_code": "554433151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6300 WEDGEWOOD RD N",
"city": "MAPLE GROVE",
"state": "MN",
"postal_code": "553113647",
"telephone_number": "763-551-1215"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OKUNEYE",
"first_name": "OLUFEMI",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-02-20",
"last_updated": "2017-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MN",
"license": "CNP-4949",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maple Grove, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.