MEDICARE: MISS OLUFUNMILAYO VICTORIA ADEFOLARIN FNP-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	363LF0000X	Family Nurse Practitioner	AP128783	TX

General Provider Information

NPI Number	:	1588025415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS OLUFUNMILAYO VICTORIA ADEFOLARIN FNP-C

Provider Business Mailing Address
First Line	:	342 DAKOTA DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-4471
Country	:	US
Telephone Number	:	817-714-4096
Fax Number	:

Provider Business Practice Location Address
First Line	:	264 FM 3478 RD
Second Line	:
City	:	HUNTSVILLE
State	:	TX
Zip	:	77320-3322
Country	:	US
Telephone Number	:	936-291-4200
Fax Number	:

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

Provider Enumeration Date	:	03/21/2016
Last Update Date	:	03/21/2016

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