Healthcare Provider Details

I. General information

NPI: 1225469976
Provider Name (Legal Business Name): MUMINOT OLOLADE OGUNMUYIWA DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2013
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 SOUTH IH 35
BELTON TX
76513-9426
US

IV. Provider business mailing address

3500 SOUTH IH 35
BELTON TX
76513-9426
US

V. Phone/Fax

Practice location:
  • Phone: 254-939-2100
  • Fax: 254-939-2334
Mailing address:
  • Phone: 254-939-2100
  • Fax: 254-939-2334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP124478
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: