Healthcare Provider Details

I. General information

NPI: 1902543374
Provider Name (Legal Business Name): OLUWAGBENGA MICHAEL OPANUGA APRN - PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1976 GARDEN AVE
EUGENE OR
97403-1933
US

IV. Provider business mailing address

1976 GARDEN AVE
EUGENE OR
97403-1933
US

V. Phone/Fax

Practice location:
  • Phone: 541-255-1411
  • Fax: 541-255-1412
Mailing address:
  • Phone: 541-255-1411
  • Fax: 541-255-1412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN95280648
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number81552
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10042777
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: