MEDICARE: OLUYEMISI ADEOLA BABAJIDE ADMINISTRATOR

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	163WA2000X	Administrator Registered Nurse	716665	TX

General Provider Information

NPI Number	:	1942489539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUYEMISI ADEOLA BABAJIDE ADMINISTRATOR

Provider Business Mailing Address
First Line	:	709 COLD CREEK DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-3038
Country	:	US
Telephone Number	:	214-448-6567
Fax Number	:	682-518-8124

Provider Business Practice Location Address
First Line	:	709 COLD CREEK DRIVE
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-3038
Country	:	US
Telephone Number	:	214-448-6567
Fax Number	:	682-518-8124

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

Provider Enumeration Date	:	10/30/2007
Last Update Date	:	04/04/2008

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