Provider Demographics
NPI:1427602366
Name:OGUNSEYITAN, ELIZABETH OLUFUNMILAYO
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:OLUFUNMILAYO
Last Name:OGUNSEYITAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 HONTLEY DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-6151
Mailing Address - Country:US
Mailing Address - Phone:214-597-9706
Mailing Address - Fax:
Practice Address - Street 1:1501 E EL PASO ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-6700
Practice Address - Country:US
Practice Address - Phone:817-569-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX346055164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse