Provider Demographics
NPI:1578455523
Name:OYETUGA, ADEMILOLA OLUFUNMIKE (NP)
Entity type:Individual
Prefix:MS
First Name:ADEMILOLA
Middle Name:OLUFUNMIKE
Last Name:OYETUGA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02129-2917
Mailing Address - Country:US
Mailing Address - Phone:253-232-3876
Mailing Address - Fax:
Practice Address - Street 1:293 MAIN ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02129-2917
Practice Address - Country:US
Practice Address - Phone:253-232-3876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2390282163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse