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General NPI Number Information
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NPI Number | 1265241210
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Entity Type | Individual
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Provider Name | OLUWASEUN MODUPE ONIFADE NP
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Gender | Female
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Dates
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Enumeration Date | 01/04/2025
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 1701 N SENATE BLVD
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-1239
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Country | US
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Telephone | 317-944-0980
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Fax |
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Provider Business Mailing Address
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Address Line | 8704 MONTERY RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46226-5550
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Country | US
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Telephone | 317-332-9667
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 71016191A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71016191A
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License Number State | IN
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