Provider Demographics
NPI:1922688019
Name:BODE-OLOYE, ANUOLUWAPO TEMITOPE
Entity type:Individual
Prefix:MRS
First Name:ANUOLUWAPO
Middle Name:TEMITOPE
Last Name:BODE-OLOYE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ANUOLUWAPO
Other - Middle Name:TEMITOPE
Other - Last Name:IJAOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:205 E UNIVERSITY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6821
Mailing Address - Country:US
Mailing Address - Phone:512-548-4954
Mailing Address - Fax:
Practice Address - Street 1:2423 WILLIAMS DR STE 108
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-3269
Practice Address - Country:US
Practice Address - Phone:877-800-5722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1030222363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health