Provider Demographics
NPI:1972050474
Name:OGUNBANWO, OYEFUNKE ABIDEMI
Entity Type:Individual
Prefix:
First Name:OYEFUNKE
Middle Name:ABIDEMI
Last Name:OGUNBANWO
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 1:13605 KESWICK LN
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-4030
Mailing Address - Country:US
Mailing Address - Phone:405-694-1313
Mailing Address - Fax:
Practice Address - Street 1:3020 NW 181ST ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-6824
Practice Address - Country:US
Practice Address - Phone:405-250-5706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL0064819372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKL0064819OtherLICENSED PRACTICAL NURSE