Provider Demographics
NPI:1770148397
Name:OPESEITAN-ODUMOSU, OLUSOLA ABOSEDE (NP-C)
Entity type:Individual
Prefix:
First Name:OLUSOLA
Middle Name:ABOSEDE
Last Name:OPESEITAN-ODUMOSU
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2059 E ECLIPSE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-4615
Mailing Address - Country:US
Mailing Address - Phone:559-273-0316
Mailing Address - Fax:559-433-0750
Practice Address - Street 1:451 E ALMOND AVE STE 103
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5562
Practice Address - Country:US
Practice Address - Phone:559-673-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95011163363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily