Provider Demographics
NPI:1871342410
Name:OGUNYEMI, ABOSEDE ELIZABETH
Entity type:Individual
Prefix:
First Name:ABOSEDE
Middle Name:ELIZABETH
Last Name:OGUNYEMI
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 1:3715 HIGHLAND WOODS WAY
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-7191
Mailing Address - Country:US
Mailing Address - Phone:469-494-7311
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:3715 HIGHLAND WOODS WAY
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-7191
Practice Address - Country:US
Practice Address - Phone:469-494-7311
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)