Provider Demographics
NPI:1679184048
Name:SOYINGBE, VIVIAN TEMILOLA
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:TEMILOLA
Last Name:SOYINGBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TEMILOLA
Other - Middle Name:VIVIAN
Other - Last Name:OMIYALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:821 LAKE SIERRA WAY
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-1237
Mailing Address - Country:US
Mailing Address - Phone:832-232-8541
Mailing Address - Fax:
Practice Address - Street 1:821 LAKE SIERRA WAY
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-1237
Practice Address - Country:US
Practice Address - Phone:832-232-8541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX937999163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX38399819OtherDRIVER LICENSE