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General NPI Number Information
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NPI Number | 1548915465
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Entity Type | Organization
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Legal Business Name | MONSURAT N OLUWA-OKOUGBO
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Dates
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Enumeration Date | 02/18/2022
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Last Update Date | 08/11/2022
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Provider Practice Location Address
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Address Line | 8539 EAGLE POINT BLVD. 100
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City | LAKE ELMO
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State | MN
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Zip | 55042
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Country | US
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Telephone | 612-643-3149
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Fax | 612-453-3133
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Provider Business Mailing Address
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Address Line | 8539 EAGLE POINT BLVD. 100
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City | LAKE ELMO
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State | MN
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Zip | 55042
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Country | US
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Telephone | 612-643-3149
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Fax | 612-453-3133
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Authorized Official
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Title or Position | PMHNP-BC
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Name | MONSURAT OLUWA-OKOUGBO
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Credential |
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Telephone | 612-643-3149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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