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General NPI Number Information
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NPI Number | 1568521573
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Entity Type | Individual
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Provider Name | OLUFUNMILOLA OGUNMODEDE RN
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Gender | Female
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 3937 IVYWOOD LN
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City | PUEBLO
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State | CO
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Zip | 81005-2551
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Country | US
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Telephone | 719-553-0111
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Fax | 833-918-2238
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Provider Business Mailing Address
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Address Line | PO BOX 9000
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City | PUEBLO
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State | CO
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Zip | 81008-9000
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Country | US
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Telephone | 719-553-0111
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Fax | 719-553-2216
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APN.0999232
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License Number State | CO
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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 | APN.0999232-NP
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 111416
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License Number State | CO
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