Provider Demographics
NPI:1922508878
Name:AIYEOLA, OMOWUNMI FOLASADE
Entity Type:Individual
Prefix:
First Name:OMOWUNMI
Middle Name:FOLASADE
Last Name:AIYEOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OMOWUNMI
Other - Middle Name:
Other - Last Name:AIYEOLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2625 STONELAKE DR APT 522
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-8789
Mailing Address - Country:US
Mailing Address - Phone:347-677-4614
Mailing Address - Fax:
Practice Address - Street 1:2625 STONELAKE DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-8790
Practice Address - Country:US
Practice Address - Phone:347-677-4614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX340593164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse