Provider Demographics
NPI:1609147180
Name:ODUNUGA, ADETONA OLADELE (APRN)
Entity Type:Individual
Prefix:MR
First Name:ADETONA
Middle Name:OLADELE
Last Name:ODUNUGA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6237 HIGHWAY 6 S STE C
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-1501
Mailing Address - Country:US
Mailing Address - Phone:281-902-2296
Mailing Address - Fax:
Practice Address - Street 1:12703 ALIEF CLODINE RD STE 103
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-5487
Practice Address - Country:US
Practice Address - Phone:281-902-2296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2022-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1088655363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health