MEDICARE: MR. ADETONA OLADELE ODUNUGA APRN

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	1088655	TX

General Provider Information

NPI Number	:	1609147180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ADETONA OLADELE ODUNUGA APRN

Provider Business Mailing Address
First Line	:	6237 HIGHWAY 6 S STE C
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-1501
Country	:	US
Telephone Number	:	281-902-2296
Fax Number	:

Provider Business Practice Location Address
First Line	:	12703 ALIEF CLODINE RD STE 103
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-5487
Country	:	US
Telephone Number	:	281-902-2296
Fax Number	:

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

Provider Enumeration Date	:	01/16/2012
Last Update Date	:	12/24/2022

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