Provider Demographics
NPI:1639247547
Name:AJELETI-OLUFADEJU, OLUSOLA OLUKEMI (RN)
Entity Type:Individual
Prefix:MRS
First Name:OLUSOLA
Middle Name:OLUKEMI
Last Name:AJELETI-OLUFADEJU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:OLUSOLA
Other - Middle Name:OLUKEMI
Other - Last Name:OLUSANYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1802 ELM SHADOW DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-2920
Mailing Address - Country:US
Mailing Address - Phone:281-499-9938
Mailing Address - Fax:281-499-9938
Practice Address - Street 1:1802 ELM SHADOW DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-2920
Practice Address - Country:US
Practice Address - Phone:281-499-9938
Practice Address - Fax:281-499-9938
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPENDING163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health