Provider Demographics
NPI:1063882306
Name:OLUDIRAN, OYINLOLA (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:OYINLOLA
Middle Name:
Last Name:OLUDIRAN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:MRS
Other - First Name:OYINLOLA
Other - Middle Name:
Other - Last Name:TAIWO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:3835 N FREEWAY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1954
Mailing Address - Country:US
Mailing Address - Phone:916-576-7900
Mailing Address - Fax:916-277-9380
Practice Address - Street 1:77 SUGAR CREEK CENTER BLVD STE 460
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3786
Practice Address - Country:US
Practice Address - Phone:855-501-1004
Practice Address - Fax:888-570-1766
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129508363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX$$$$$$$$$OtherAMBULATORY SERVICES