Provider Demographics
NPI:1003301953
Name:OYEWOLE, OLUWAFEMI
Entity Type:Individual
Prefix:MR
First Name:OLUWAFEMI
Middle Name:
Last Name:OYEWOLE
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:FEMI
Other - Middle Name:T
Other - Last Name:OYEWOLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:3227 MEADE AVE STE 5B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-7810
Mailing Address - Country:US
Mailing Address - Phone:725-333-2411
Mailing Address - Fax:702-952-5257
Practice Address - Street 1:3227 MEADE AVE STE 5B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-7810
Practice Address - Country:US
Practice Address - Phone:725-333-2411
Practice Address - Fax:702-952-5257
Is Sole Proprietor?:No
Enumeration Date:2018-06-23
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS78306363LA2100X, 363LF0000X, 363LP0808X
NV841535363LP0808X
TXAP138134363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health