Provider Demographics
NPI:1972808962
Name:IYANOYE, SERA OLUWAKEMI (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:SERA
Middle Name:OLUWAKEMI
Last Name:IYANOYE
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 211699
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-3699
Mailing Address - Country:US
Mailing Address - Phone:866-849-0692
Mailing Address - Fax:
Practice Address - Street 1:20405 STATE HIGHWAY 249 STE 325
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-2893
Practice Address - Country:US
Practice Address - Phone:866-849-0692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP120320363LF0000X
FLARNP9270527363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2847097-01Medicaid
TX0016SHOtherBCBS
TX858N19OtherBCBS
TXAP120320OtherTEXAS BOARD OF NURSING
TXP00969514OtherPALMETTO RR
TX2035487-02Medicaid
TXD07564OtherMEDICARE RR PALMETTO
TXTXB132653Medicare PIN