Provider Demographics
NPI:1598906398
Name:OLU-ILESANMI, DEBORAH ADENIKE
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:ADENIKE
Last Name:OLU-ILESANMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:OLUKAYODE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2011 W IRVING BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-4353
Mailing Address - Country:US
Mailing Address - Phone:469-328-1789
Mailing Address - Fax:817-417-4488
Practice Address - Street 1:2011 W IRVING BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-4353
Practice Address - Country:US
Practice Address - Phone:469-328-1789
Practice Address - Fax:817-417-4488
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health