MEDICARE: ADEBIMPE BLESSING OGUNSEFUNMI NP-C

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	363L00000X	Nurse Practitioner	355748	NY
2	363LF0000X	Family Nurse Practitioner	95033275	CA
3	363LP2300X	Primary Care Nurse Practitioner	AP130385	TX
4	363L00000X	Nurse Practitioner	AP130385	TX
5	363LF0000X	Family Nurse Practitioner	AP130385	TX
6	363LF0000X	Family Nurse Practitioner	APRN11038585	FL

General Provider Information

NPI Number	:	1093269722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADEBIMPE BLESSING OGUNSEFUNMI NP-C

Provider Business Mailing Address
First Line	:	11511 SHADOW CREEK PKWY
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-7298
Country	:	US
Telephone Number	:	713-442-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	611 GATEWAY BLVD STE 120
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-7066
Country	:	US
Telephone Number	:	650-761-4056
Fax Number	:

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

Provider Enumeration Date	:	08/11/2016
Last Update Date	:	11/26/2025

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