Healthcare Provider Details

I. General information

NPI: 1053524025
Provider Name (Legal Business Name): YEWANDE ABIOLA OGUNYEMI R.N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 10/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S LANCASTER RD
DALLAS TX
75216-7167
US

IV. Provider business mailing address

236 BRICKNELL LN
COPPELL TX
75019-2597
US

V. Phone/Fax

Practice location:
  • Phone: 214-857-2098
  • Fax:
Mailing address:
  • Phone: 972-471-0131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number705172
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: