Provider Demographics
NPI:1558739730
Name:AWE, OLUBUNMI (NP)
Entity Type:Individual
Prefix:
First Name:OLUBUNMI
Middle Name:
Last Name:AWE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5160 FINNHORSE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-2562
Mailing Address - Country:US
Mailing Address - Phone:214-400-2000
Mailing Address - Fax:
Practice Address - Street 1:830 MAYFIELD RD
Practice Address - Street 2:STE 100
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3728
Practice Address - Country:US
Practice Address - Phone:214-400-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-04
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128858363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily