Individual
MR. SAMUEL OLAOLUWA OMOLADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN PMHNP
Contact information
Practice address
11650 MCCREE RD, DALLAS, TX 75238-5224
(718) 304-4906
Mailing address
11650 MCCREE RD APT 2034, DALLAS, TX 75238-3245
(718) 304-4906
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
958104
TX
164W00000X
Licensed Practical Nurse
320878-1
NY
171M00000X
Case Manager/Care Coordinator
958104
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1099855
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP61366158
WA
Other
Enumeration date
06/07/2017
Last updated
07/15/2023
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