Provider Demographics
NPI:1093576605
Name:AROWOGBOLA, BOLANLE OLABISI (FNP -C)
Entity Type:Individual
Prefix:
First Name:BOLANLE
Middle Name:OLABISI
Last Name:AROWOGBOLA
Suffix:
Gender:F
Credentials:FNP -C
Other - Prefix:
Other - First Name:BOLANLE
Other - Middle Name:OLABISI
Other - Last Name:AFOLABI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2122 MOSS BLUFF LN
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-5238
Mailing Address - Country:US
Mailing Address - Phone:215-609-5527
Mailing Address - Fax:
Practice Address - Street 1:2122 MOSS BLUFF LN
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-5238
Practice Address - Country:US
Practice Address - Phone:215-609-5527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1141223363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily