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General NPI Number Information
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NPI Number | 1326969825
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Entity Type | Individual
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Provider Name | NANA FAJUGBAGBE FNP
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Gender | Female
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Dates
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Enumeration Date | 07/22/2026
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Last Update Date | 07/22/2026
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Provider Practice Location Address
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Address Line | 1216 E KENOSHA ST # 320
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City | BROKEN ARROW
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State | OK
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Zip | 74012-2007
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Country | US
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Telephone | 918-744-3131
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Fax |
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Provider Business Mailing Address
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Address Line | 10218 S 229TH EAST AVE
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City | BROKEN ARROW
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State | OK
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Zip | 74014-6268
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209705
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License Number State | OK
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