Healthcare Provider Details

I. General information

NPI: 1366936312
Provider Name (Legal Business Name): ABOSEDE BOLANLE OKUWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1914 ENGLISH ELM ST
HOUSTON TX
77067-3941
US

IV. Provider business mailing address

1914 ENGLISH ELM ST
HOUSTON TX
77067-3941
US

V. Phone/Fax

Practice location:
  • Phone: 713-300-4643
  • Fax:
Mailing address:
  • Phone: 713-300-4643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP137770
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: