Healthcare Provider Details

I. General information

NPI: 1972407260
Provider Name (Legal Business Name): DASOLA S GBOLUAJE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S HIGHWAY 183
LEANDER TX
78641-1991
US

IV. Provider business mailing address

801 S HIGHWAY 183
LEANDER TX
78641-1991
US

V. Phone/Fax

Practice location:
  • Phone: 512-843-5522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1035625
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: