Provider Demographics
NPI:1386203289
Name:OGUNSOLA, OLUKUNMI
Entity Type:Individual
Prefix:
First Name:OLUKUNMI
Middle Name:
Last Name:OGUNSOLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 LAKE PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-1276
Mailing Address - Country:US
Mailing Address - Phone:469-443-2001
Mailing Address - Fax:
Practice Address - Street 1:704 LAKE PLEASANT RD
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-1276
Practice Address - Country:US
Practice Address - Phone:469-443-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX313592164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse