Provider Demographics
NPI:1750179875
Name:OLATUNDE, GRACE ESEOHE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ESEOHE
Last Name:OLATUNDE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4009 COBBLESTONE DR APT 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-9627
Mailing Address - Country:US
Mailing Address - Phone:910-479-6233
Mailing Address - Fax:
Practice Address - Street 1:4009 COBBLESTONE DR APT 4
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-9627
Practice Address - Country:US
Practice Address - Phone:910-479-6233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2025002667363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily