Healthcare Provider Details

I. General information

NPI: 1457869992
Provider Name (Legal Business Name): RACHEL OLUWASEUNAYO OLUGBENGA FPA, FNP-BC, DNP.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL OLAOYE

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 BROADWAY N
FARGO ND
58102-1406
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-2900
  • Fax: 701-234-2996
Mailing address:
  • Phone: 605-328-6585
  • Fax: 605-328-6512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberCP002091
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277.001336
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: