Provider Demographics
NPI:1417550773
Name:AYANSOLA OWOADE, EUNICE OLUFUNKE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:EUNICE
Middle Name:OLUFUNKE
Last Name:AYANSOLA OWOADE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26334 SERENITY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-5406
Mailing Address - Country:US
Mailing Address - Phone:732-766-5204
Mailing Address - Fax:
Practice Address - Street 1:26334 SERENITY OAKS DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-5406
Practice Address - Country:US
Practice Address - Phone:732-766-5204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX907031163WE0003X
TX1031295363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency