Provider Demographics
NPI:1508604422
Name:ADELAGUN, OLANREWAJU (RN)
Entity type:Individual
Prefix:
First Name:OLANREWAJU
Middle Name:
Last Name:ADELAGUN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15125 WEST RD APT 1235
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-3162
Mailing Address - Country:US
Mailing Address - Phone:832-889-5503
Mailing Address - Fax:
Practice Address - Street 1:4611 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-4731
Practice Address - Country:US
Practice Address - Phone:281-903-7691
Practice Address - Fax:346-754-3490
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX898881364SP0813X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0813XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Geropsychiatric