Provider Demographics
NPI:1801314430
Name:OLUWUNMI, OMOBOLANLE AANUOLUWA (AGNP-C, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:OMOBOLANLE
Middle Name:AANUOLUWA
Last Name:OLUWUNMI
Suffix:
Gender:F
Credentials:AGNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3542 HEARTLAND KEY LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-1408
Mailing Address - Country:US
Mailing Address - Phone:281-704-8923
Mailing Address - Fax:
Practice Address - Street 1:3542 HEARTLAND KEY LANE
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494
Practice Address - Country:US
Practice Address - Phone:281-704-8923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-04
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135016363LG0600X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty