Healthcare Provider Details

I. General information

NPI: 1053971804
Provider Name (Legal Business Name): OLAIDE OLUFUNMILAYO OWOLOYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 E 1ST ST STE F
CHANDLER OK
74834-2483
US

IV. Provider business mailing address

1920 E 1ST ST STE F
CHANDLER OK
74834-2483
US

V. Phone/Fax

Practice location:
  • Phone: 405-654-0013
  • Fax:
Mailing address:
  • Phone: 405-654-0013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number215940
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: