Healthcare Provider Details

I. General information

NPI: 1528691607
Provider Name (Legal Business Name): ANNAH MOTUNRAYO OLAOMO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 WORTH ST APT 227
ARLINGTON TX
76014-3545
US

IV. Provider business mailing address

2101 WORTH ST APT 227
ARLINGTON TX
76014-3545
US

V. Phone/Fax

Practice location:
  • Phone: 682-248-2057
  • Fax:
Mailing address:
  • Phone: 682-248-2057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number957178
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: