Provider Demographics
NPI:1568747111
Name:OMOLE, OLUFUNMILAYO PRISCILLA (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:OLUFUNMILAYO
Middle Name:PRISCILLA
Last Name:OMOLE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17903 HOLLOW HILL LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2577
Mailing Address - Country:US
Mailing Address - Phone:281-989-3039
Mailing Address - Fax:
Practice Address - Street 1:15551 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3830
Practice Address - Country:US
Practice Address - Phone:281-325-1010
Practice Address - Fax:281-325-1060
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX720034363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics