Provider Demographics
NPI:1134687940
Name:ONIPEDE, OLUWABUSOLA (FNP- BC)
Entity Type:Individual
Prefix:
First Name:OLUWABUSOLA
Middle Name:
Last Name:ONIPEDE
Suffix:
Gender:F
Credentials:FNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 WILLOW FIN WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-2705
Mailing Address - Country:US
Mailing Address - Phone:832-623-3355
Mailing Address - Fax:
Practice Address - Street 1:2111 E DENMAN AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-6243
Practice Address - Country:US
Practice Address - Phone:936-899-7242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85163363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty