Provider Demographics
NPI:1861893687
Name:OLUSANYA, JOHNSON OLUROTIMI (NP)
Entity type:Individual
Prefix:MR
First Name:JOHNSON
Middle Name:OLUROTIMI
Last Name:OLUSANYA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16350 ANGEL ISLAND LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77053-4336
Mailing Address - Country:US
Mailing Address - Phone:713-553-3560
Mailing Address - Fax:
Practice Address - Street 1:16350 ANGEL ISLAND LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77053-4336
Practice Address - Country:US
Practice Address - Phone:713-553-3560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126233363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily