Healthcare Provider Details

I. General information

NPI: 1386027589
Provider Name (Legal Business Name): MRS. OLAJUMOKE OLUWASEUN OYEBODE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11010 LOCHRANZA LN
RICHMOND TX
77407-1547
US

IV. Provider business mailing address

11010 LOCHRANZA LN
RICHMOND TX
77407-1547
US

V. Phone/Fax

Practice location:
  • Phone: 612-414-4721
  • Fax:
Mailing address:
  • Phone: 612-414-4721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: