Healthcare Provider Details

I. General information

NPI: 1619418209
Provider Name (Legal Business Name): OPEYEMI OLOYEDE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2017
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3213 S 49TH AVE
OMAHA NE
68106-4007
US

IV. Provider business mailing address

3213 S 49TH AVE
OMAHA NE
68106-4007
US

V. Phone/Fax

Practice location:
  • Phone: 402-216-1760
  • Fax:
Mailing address:
  • Phone: 402-216-1760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number80861
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number80861
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number80861
License Number StateNE
# 4
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number80861
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: