1457869992 NPI number — DR. RACHEL OLUWASEUNAYO OLUGBENGA FPA, FNP-BC, DNP.

Table of content: DR. RACHEL OLUWASEUNAYO OLUGBENGA FPA, FNP-BC, DNP. (NPI 1457869992)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457869992 NPI number — DR. RACHEL OLUWASEUNAYO OLUGBENGA FPA, FNP-BC, DNP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLUGBENGA
Provider First Name:
RACHEL
Provider Middle Name:
OLUWASEUNAYO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
FPA, FNP-BC, DNP.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457869992
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 N 2ND AVE W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAITH
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57626-6086
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-967-2644
Provider Business Mailing Address Fax Number:
866-423-6811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 N 2ND AVE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAITH
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57626-6086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-967-2644
Provider Business Practice Location Address Fax Number:
866-423-6811
Provider Enumeration Date:
01/18/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  277.001336 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X , with the licence number: CP002091 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)