Healthcare Provider Details

I. General information

NPI: 1073481495
Provider Name (Legal Business Name): AUGUSTINE OLOYEDE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16503 129TH AVENUE CT E
PUYALLUP WA
98374-9605
US

IV. Provider business mailing address

16503 129TH AVENUE CT E
PUYALLUP WA
98374-9605
US

V. Phone/Fax

Practice location:
  • Phone: 412-641-0605
  • Fax:
Mailing address:
  • Phone: 412-641-0605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61388534
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: