MEDICARE: ADE OGUNMOKUN APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	733211	TX

General Provider Information

NPI Number	:	1043639891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADE OGUNMOKUN APN

Provider Business Mailing Address
First Line	:	2600 GESSNER RD STE 280
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77080-3898
Country	:	US
Telephone Number	:	713-468-6538
Fax Number	:	713-468-1042

Provider Business Practice Location Address
First Line	:	2600 GESSNER RD STE 280
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77080-3898
Country	:	US
Telephone Number	:	713-468-6538
Fax Number	:	713-468-1042

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2014
Last Update Date	:	04/09/2014

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