Healthcare Provider Details

I. General information

NPI: 1821454935
Provider Name (Legal Business Name): OLALEYE AUGUSTINE OLOWOOKERE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2016
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 CYPRESSWOOD LN
MANSFIELD TX
76063-7294
US

IV. Provider business mailing address

2704 WATERWAY DR
GRAND PRAIRIE TX
75054-7251
US

V. Phone/Fax

Practice location:
  • Phone: 312-451-6917
  • Fax: 214-945-1009
Mailing address:
  • Phone: 312-451-6917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number814598
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: