Provider Demographics
NPI:1386257814
Name:OYEWOLE, DANIEL OYEWUSI (NP)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:OYEWUSI
Last Name:OYEWOLE
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 1:4051 HUNTERS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-2549
Mailing Address - Country:US
Mailing Address - Phone:240-533-5534
Mailing Address - Fax:
Practice Address - Street 1:4051 HUNTERS CREEK DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-2549
Practice Address - Country:US
Practice Address - Phone:240-533-5534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1010546363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health