MEDICARE: YETUNDE CHRISTIANA OGUNJUMELO ARPN-CNP

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	163W00000X	Registered Nurse	936255	TX
2	363LF0000X	Family Nurse Practitioner	1055946	TX

General Provider Information

NPI Number	:	1891315479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YETUNDE CHRISTIANA OGUNJUMELO ARPN-CNP

Provider Business Mailing Address
First Line	:	1100 WILCREST DR STE 121
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-1642
Country	:	US
Telephone Number	:	346-388-0388
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 WILCREST DR STE 121
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-1642
Country	:	US
Telephone Number	:	346-388-0388
Fax Number	:

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

Provider Enumeration Date	:	04/23/2020
Last Update Date	:	03/22/2023

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