Provider Demographics
NPI:1730349937
Name:OLUWOLE, OLANIKE
Entity type:Individual
Prefix:
First Name:OLANIKE
Middle Name:
Last Name:OLUWOLE
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 1:982 N GARDEN RIDGE BLVD
Mailing Address - Street 2:STE.220B
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-2827
Mailing Address - Country:US
Mailing Address - Phone:972-219-1200
Mailing Address - Fax:972-434-0400
Practice Address - Street 1:982 N GARDEN RIDGE BLVD
Practice Address - Street 2:STE.220B
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-2827
Practice Address - Country:US
Practice Address - Phone:972-219-1200
Practice Address - Fax:972-434-0400
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010557163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679716Medicare Oscar/Certification