Provider Demographics
NPI:1053971804
Name:OWOLOYE, OLAIDE OLUFUNMILAYO
Entity type:Individual
Prefix:
First Name:OLAIDE
Middle Name:OLUFUNMILAYO
Last Name:OWOLOYE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 E 1ST ST STE F
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:OK
Mailing Address - Zip Code:74834-2483
Mailing Address - Country:US
Mailing Address - Phone:405-654-0013
Mailing Address - Fax:
Practice Address - Street 1:1920 E 1ST ST STE F
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:OK
Practice Address - Zip Code:74834-2483
Practice Address - Country:US
Practice Address - Phone:405-654-0013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-14
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK215940363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily