Provider Demographics
NPI:1669513297
Name:OSIBAMOWO, ADESOLA M (RN)
Entity type:Individual
Prefix:MRS
First Name:ADESOLA
Middle Name:M
Last Name:OSIBAMOWO
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 1:1000 AUDELIA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5168
Mailing Address - Country:US
Mailing Address - Phone:972-952-1478
Mailing Address - Fax:972-952-1479
Practice Address - Street 1:1000 AUDELIA RD STE 100
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5168
Practice Address - Country:US
Practice Address - Phone:972-952-1478
Practice Address - Fax:972-952-1479
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010118251E00000X
TX649708163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No251E00000XAgenciesHome Health