Organization
STEDICLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLAYINKA AGBODO FNP (FAMILY NURSE PRACTITIONER)
(832) 745-8742
Entity
Organization
Contact information
Practice address
4560 FM 1960 RD W STE 106, HOUSTON, TX 77069
(832) 286-1061
(832) 286-1267
Mailing address
4560 FM 1960 RD W STE 106, HOUSTON, TX 77069-4628
(832) 286-1061
(832) 286-1267
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
TX
363LF0000X
Family Nurse Practitioner
AP128483
TX
363LF0000X
Family Nurse Practitioner
AP130092
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659746675
—
TX
05
—
358389004
—
TX
05
—
3604894
—
TX
Enumeration date
12/02/2015
Last updated
06/26/2018
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