Provider Demographics
NPI:1417590480
Name:BANWO, OLAYEMI OLUKEMI (FNP)
Entity Type:Individual
Prefix:
First Name:OLAYEMI
Middle Name:OLUKEMI
Last Name:BANWO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 LAMPLIGHT WAY
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5608
Mailing Address - Country:US
Mailing Address - Phone:214-326-8814
Mailing Address - Fax:
Practice Address - Street 1:120 S CENTRAL EXPY STE 102
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-3753
Practice Address - Country:US
Practice Address - Phone:972-547-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141849363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily