Provider Demographics
NPI:1639650302
Name:OLOYEDE, OLUFUNKE (LVN)
Entity Type:Individual
Prefix:
First Name:OLUFUNKE
Middle Name:
Last Name:OLOYEDE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 W 15TH ST STE 1025
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7253
Mailing Address - Country:US
Mailing Address - Phone:972-673-0404
Mailing Address - Fax:
Practice Address - Street 1:1255 W 15TH ST STE 1205
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075
Practice Address - Country:US
Practice Address - Phone:972-673-0404
Practice Address - Fax:972-673-0420
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX229033164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX229033OtherLVN