Provider Demographics
NPI:1861637548
Name:OLADEJI, OLAWUMI O
Entity type:Individual
Prefix:MS
First Name:OLAWUMI
Middle Name:O
Last Name:OLADEJI
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 1:423 W WHEATLAND RD STE 102
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4630
Mailing Address - Country:US
Mailing Address - Phone:469-569-8087
Mailing Address - Fax:469-375-3983
Practice Address - Street 1:423 W WHEATLAND RD STE 102
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4630
Practice Address - Country:US
Practice Address - Phone:469-569-8087
Practice Address - Fax:469-375-3983
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No372500000XNursing Service Related ProvidersChore Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1073801437OtherCDS (FMSA)