Provider Demographics
NPI:1720662588
Name:SHOYOMBO, RILWAN OLALEKAN (APRN)
Entity Type:Individual
Prefix:
First Name:RILWAN
Middle Name:OLALEKAN
Last Name:SHOYOMBO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5353 S JONES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-0537
Mailing Address - Country:US
Mailing Address - Phone:702-846-5978
Mailing Address - Fax:702-846-0305
Practice Address - Street 1:5353 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-0537
Practice Address - Country:US
Practice Address - Phone:702-846-5978
Practice Address - Fax:702-846-0305
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-07
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV839759363LA2200X, 363LP2300X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care