Provider Demographics
NPI:1578123923
Name:SHOBOWALE, OLUBUKOLA
Entity Type:Individual
Prefix:
First Name:OLUBUKOLA
Middle Name:
Last Name:SHOBOWALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8585 SIENNA SPRINGS BLVD APT 1223
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-7206
Mailing Address - Country:US
Mailing Address - Phone:832-526-9204
Mailing Address - Fax:
Practice Address - Street 1:8585 SIENNA SPRINGS BLVD APT 1223
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-7206
Practice Address - Country:US
Practice Address - Phone:832-526-9204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX874840163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse