Provider Demographics
NPI:1386913382
Name:OJO, OMOWUNMI OLUWATOSIN (LPN)
Entity type:Individual
Prefix:
First Name:OMOWUNMI
Middle Name:OLUWATOSIN
Last Name:OJO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 LONGMIRE RD STE 243
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-1850
Mailing Address - Country:US
Mailing Address - Phone:936-668-1479
Mailing Address - Fax:
Practice Address - Street 1:704 LONGMIRE RD STE 243
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-1850
Practice Address - Country:US
Practice Address - Phone:936-668-1479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303429164W00000X
NJ26NP06591200164W00000X
TX1073707363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX917994OtherBOARD OF NURSING
NY303429OtherLPN LICENSE