Provider Demographics
NPI:1104677087
Name:AFOLABI, ABIOLA O
Entity type:Individual
Prefix:MISS
First Name:ABIOLA
Middle Name:O
Last Name:AFOLABI
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ABIOLA
Other - Middle Name:O
Other - Last Name:OLAWOYIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:1015 BRIAR PASS
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-1893
Mailing Address - Country:US
Mailing Address - Phone:936-668-1504
Mailing Address - Fax:
Practice Address - Street 1:550 GREENS PKWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77067-4537
Practice Address - Country:US
Practice Address - Phone:713-486-5600
Practice Address - Fax:713-486-5562
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program