Provider Demographics
NPI:1346852191
Name:OLAJIDE, OLUDARI OLUTOKUNBO (APRN)
Entity Type:Individual
Prefix:MRS
First Name:OLUDARI
Middle Name:OLUTOKUNBO
Last Name:OLAJIDE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 N COUNCIL RD APT 3
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-4366
Mailing Address - Country:US
Mailing Address - Phone:405-532-3953
Mailing Address - Fax:
Practice Address - Street 1:10700 N COUNCIL RD APT 3
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-4366
Practice Address - Country:US
Practice Address - Phone:405-532-3953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK113962363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care