Provider Demographics
NPI:1033842810
Name:ODUYEJO, TEMILOLUWA OLATUNDE (NP)
Entity type:Individual
Prefix:MISS
First Name:TEMILOLUWA
Middle Name:OLATUNDE
Last Name:ODUYEJO
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 1:2205 W WALKER ST APT 3232
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-7052
Mailing Address - Country:US
Mailing Address - Phone:386-262-2166
Mailing Address - Fax:
Practice Address - Street 1:2205 W WALKER ST APT 3232
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-7052
Practice Address - Country:US
Practice Address - Phone:386-262-2166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1018126363LF0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program