Healthcare Provider Details

I. General information

NPI: 1336419472
Provider Name (Legal Business Name): CHRISTIANAH OGUNLEYE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2012
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 E US HIGHWAY 80
FORNEY TX
75126-8622
US

IV. Provider business mailing address

775 E US HIGHWAY 80
FORNEY TX
75126-8622
US

V. Phone/Fax

Practice location:
  • Phone: 972-552-1634
  • Fax:
Mailing address:
  • Phone: 972-552-1634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP121138
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number715665
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: