MEDICARE: MR. OLAWALE H ADIO ODUOLA PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP144900	TX

General Provider Information

NPI Number	:	1508497108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. OLAWALE H ADIO ODUOLA PMHNP

Provider Business Mailing Address
First Line	:	15500 VOSS RD STE 1045
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77498-4601
Country	:	US
Telephone Number	:	713-309-6406
Fax Number	:	949-863-2663

Provider Business Practice Location Address
First Line	:	15500 VOSS RD STE 1045
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77498-4601
Country	:	US
Telephone Number	:	713-309-6406
Fax Number	:	949-863-2663

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2020
Last Update Date	:	08/03/2022

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