Provider Demographics
NPI:1801352976
Name:OGUNADE, OLUWAYEMISI OMOBOLANLE
Entity type:Individual
Prefix:
First Name:OLUWAYEMISI
Middle Name:OMOBOLANLE
Last Name:OGUNADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 WADSACK DR APT C
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-7226
Mailing Address - Country:US
Mailing Address - Phone:405-395-7681
Mailing Address - Fax:
Practice Address - Street 1:7117 E RENO AVE
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4444
Practice Address - Country:US
Practice Address - Phone:405-361-5488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator