Provider Demographics
NPI:1548915465
Name:MONSURAT N OLUWA-OKOUGBO
Entity type:Organization
Organization Name:MONSURAT N OLUWA-OKOUGBO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:MONSURAT
Authorized Official - Middle Name:
Authorized Official - Last Name:OLUWA-OKOUGBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-643-3149
Mailing Address - Street 1:8539 EAGLE POINT BLVD.
Mailing Address - Street 2:100
Mailing Address - City:LAKE ELMO
Mailing Address - State:MN
Mailing Address - Zip Code:55042
Mailing Address - Country:US
Mailing Address - Phone:612-643-3149
Mailing Address - Fax:612-453-3133
Practice Address - Street 1:8539 EAGLE POINT BLVD.
Practice Address - Street 2:100
Practice Address - City:LAKE ELMO
Practice Address - State:MN
Practice Address - Zip Code:55042
Practice Address - Country:US
Practice Address - Phone:612-643-3149
Practice Address - Fax:612-453-3133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty