Provider Demographics
NPI:1912485608
Name:OKEWOLE, OYEBOLA (LVN)
Entity Type:Individual
Prefix:
First Name:OYEBOLA
Middle Name:
Last Name:OKEWOLE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 PARK PLACE BLVD APT 335
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77469-5066
Mailing Address - Country:US
Mailing Address - Phone:832-298-5124
Mailing Address - Fax:
Practice Address - Street 1:601 PARK PLACE BLVD APT 335
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77469-5066
Practice Address - Country:US
Practice Address - Phone:832-298-5124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200553164X00000X
TX1000198163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse