Provider Demographics
NPI:1922589175
Name:ONASANYA, OLAITAN MEMUNAT (LVN)
Entity Type:Individual
Prefix:
First Name:OLAITAN
Middle Name:MEMUNAT
Last Name:ONASANYA
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 1:7314 WIMBERLY OAKS LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-1589
Mailing Address - Country:US
Mailing Address - Phone:773-983-4811
Mailing Address - Fax:
Practice Address - Street 1:10522 TRIPP LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-2121
Practice Address - Country:US
Practice Address - Phone:832-692-6802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-26
Last Update Date:2018-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314799164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX314799Medicaid