Provider Demographics
NPI:1356125322
Name:OYENUGA, IBUKUN AGNES (NP)
Entity type:Individual
Prefix:
First Name:IBUKUN
Middle Name:AGNES
Last Name:OYENUGA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1246 SCOTLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46231-5240
Mailing Address - Country:US
Mailing Address - Phone:317-908-3086
Mailing Address - Fax:
Practice Address - Street 1:1246 SCOTLAND BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46231-5240
Practice Address - Country:US
Practice Address - Phone:317-908-3086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71014202A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily