Provider Demographics
NPI:1619418209
Name:OLOYEDE, OPEYEMI (RN)
Entity Type:Individual
Prefix:
First Name:OPEYEMI
Middle Name:
Last Name:OLOYEDE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3213 S 49TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-4007
Mailing Address - Country:US
Mailing Address - Phone:402-216-1760
Mailing Address - Fax:
Practice Address - Street 1:3213 S 49TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-4007
Practice Address - Country:US
Practice Address - Phone:402-216-1760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE80861163WC0400X, 163WC0400X, 163W00000X, 163WC1500X, 163WH0200X, 163WP0808X
372600000X, 374U00000X, 372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE80861OtherRN LICENSE