Provider Demographics
NPI:1356096101
Name:BANKOLE, OLAWALE MUSBAU (NP)
Entity Type:Individual
Prefix:
First Name:OLAWALE
Middle Name:MUSBAU
Last Name:BANKOLE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7613 ALDERS GATE LN
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-1575
Mailing Address - Country:US
Mailing Address - Phone:817-724-4584
Mailing Address - Fax:
Practice Address - Street 1:7613 ALDERS GATE LN
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-1575
Practice Address - Country:US
Practice Address - Phone:817-724-4584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1069538363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily