Provider Demographics
NPI:1881314557
Name:ADEBOLA, OLUYEMI
Entity type:Individual
Prefix:
First Name:OLUYEMI
Middle Name:
Last Name:ADEBOLA
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 1:1315 SUMMER TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-6904
Mailing Address - Country:US
Mailing Address - Phone:443-470-2253
Mailing Address - Fax:
Practice Address - Street 1:1315 SUMMER TERRACE DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-6904
Practice Address - Country:US
Practice Address - Phone:443-470-2253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1082870163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse