Provider Demographics
NPI:1043611171
Name:OKETUNMBI, OLUBUNMI
Entity Type:Individual
Prefix:
First Name:OLUBUNMI
Middle Name:
Last Name:OKETUNMBI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13828 SUTHERLAND SPRING LN
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-2149
Mailing Address - Country:US
Mailing Address - Phone:346-715-6084
Mailing Address - Fax:281-595-7668
Practice Address - Street 1:13828 SUTHERLAND SPRING LN
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-2149
Practice Address - Country:US
Practice Address - Phone:719-406-9160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX869199251G00000X, 253Z00000X, 251E00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No253Z00000XAgenciesIn Home Supportive Care
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1043687908OtherNPI