Provider Demographics
NPI:1841781770
Name:OLADOSU, YETUNDE TOLULOPE
Entity Type:Individual
Prefix:
First Name:YETUNDE
Middle Name:TOLULOPE
Last Name:OLADOSU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 W WALNUT HILL LN
Mailing Address - Street 2:STE 155F
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3032
Mailing Address - Country:US
Mailing Address - Phone:214-305-2666
Mailing Address - Fax:
Practice Address - Street 1:7710 OAKDELL WAY APT 1202
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1974
Practice Address - Country:US
Practice Address - Phone:240-644-9517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-26
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137594363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily