MEDICARE: TOLULOPE OMOLAYO AWOLAJA GNP-BC

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	363LG0600X	Gerontology Nurse Practitioner	CNP-01943	NM
2	363LG0600X	Gerontology Nurse Practitioner	760427	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	309453YUD3	OTHER	NM	MEDICARE PTAN

General Provider Information

NPI Number	:	1548538820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOLULOPE OMOLAYO AWOLAJA GNP-BC

Provider Business Mailing Address
First Line	:	8471 GULF FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77017-5001
Country	:	US
Telephone Number	:	832-709-2770
Fax Number	:	832-924-0113

Provider Business Practice Location Address
First Line	:	8471 GULF FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77017-5001
Country	:	US
Telephone Number	:	832-709-2770
Fax Number	:	832-924-0113

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

Provider Enumeration Date	:	12/01/2011
Last Update Date	:	04/05/2023

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