Healthcare Provider Details

I. General information

NPI: 1417836149
Provider Name (Legal Business Name): MRS. BOLANLE EUNICE OGUNDELE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10777 ILLINOIS ST
CARMEL IN
46032-8972
US

IV. Provider business mailing address

780 STAYMAN WAY
WESTFIELD IN
46074-6137
US

V. Phone/Fax

Practice location:
  • Phone: 214-286-3432
  • Fax:
Mailing address:
  • Phone: 214-286-3432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License Number28275714C
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: