Provider Demographics
NPI:1730523606
Name:OBAJOLU, OLUWASEUN O (APRN)
Entity type:Individual
Prefix:
First Name:OLUWASEUN
Middle Name:O
Last Name:OBAJOLU
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3943 FLORAL WAY CT
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-7058
Mailing Address - Country:US
Mailing Address - Phone:346-410-6438
Mailing Address - Fax:
Practice Address - Street 1:3943 FLORAL WAY CT
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-7058
Practice Address - Country:US
Practice Address - Phone:346-410-6438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR186694163W00000X
TX1124763363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse