MEDICARE: OLUBUSAYO LAWRENCE DNP, APRN, FNP

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	1178777	TX
2	163W00000X	Registered Nurse	958489	TX

General Provider Information

NPI Number	:	1679123103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUBUSAYO LAWRENCE DNP, APRN, FNP

Provider Business Mailing Address
First Line	:	1155 DAIRY ASHFORD RD STE 560
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-3035
Country	:	US
Telephone Number	:	713-799-2200
Fax Number	:

Provider Business Practice Location Address
First Line	:	3724 FM 1960 RD W STE 337
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-3528
Country	:	US
Telephone Number	:	832-622-1456
Fax Number	:

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

Provider Enumeration Date	:	09/17/2019
Last Update Date	:	01/14/2025

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