Provider Demographics
NPI:1457869992
Name:OLUGBENGA, RACHEL OLUWASEUNAYO (FPA, FNP-BC, DNP)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:OLUWASEUNAYO
Last Name:OLUGBENGA
Suffix:
Gender:F
Credentials:FPA, FNP-BC, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 N 2ND AVE W
Mailing Address - Street 2:
Mailing Address - City:FAITH
Mailing Address - State:SD
Mailing Address - Zip Code:57626-6086
Mailing Address - Country:US
Mailing Address - Phone:605-967-2644
Mailing Address - Fax:866-423-6811
Practice Address - Street 1:112 N 2ND AVE W
Practice Address - Street 2:
Practice Address - City:FAITH
Practice Address - State:SD
Practice Address - Zip Code:57626-6086
Practice Address - Country:US
Practice Address - Phone:605-967-2644
Practice Address - Fax:866-423-6811
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277.001336363LF0000X
SDCP002091363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily