Provider Demographics
NPI:1689379364
Name:ABORISADE, OLUBUNMI (DNP)
Entity Type:Individual
Prefix:DR
First Name:OLUBUNMI
Middle Name:
Last Name:ABORISADE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:BUNMI
Other - Middle Name:
Other - Last Name:ABORISADE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:23015 FM 529 RD
Mailing Address - Street 2:STE 200 PMB1066
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-5065
Mailing Address - Country:US
Mailing Address - Phone:661-862-9370
Mailing Address - Fax:
Practice Address - Street 1:23015 FM 529 RD
Practice Address - Street 2:STE 200 PMB1066
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-5065
Practice Address - Country:US
Practice Address - Phone:661-862-9370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF03230699363LF0000X
TX2023062816363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty