Healthcare Provider Details

I. General information

NPI: 1487360426
Provider Name (Legal Business Name): OLUGBENGA FRANCIS AKINWUNTAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 LINCOLNTON RD STE E
SALISBURY NC
28144-6277
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-637-1123
  • Fax: 704-637-1214
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF10220574
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5018014
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: