Healthcare Provider Details

I. General information

NPI: 1659170033
Provider Name (Legal Business Name): QAUSARAT OGUNNEYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1482 S 84TH ST APT 136
WEST ALLIS WI
53214-4420
US

IV. Provider business mailing address

1482 S 84TH ST APT 136
WEST ALLIS WI
53214-4420
US

V. Phone/Fax

Practice location:
  • Phone: 832-834-2714
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: