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Individual

OLUSADE O FAKOLADE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
833 PARK EAST BLVD, LAFAYETTE, IN 47905-0785
(765) 743-4400
Mailing address
5477 RALFE RD, INDIANAPOLIS, IN 46234-3753
(317) 457-7329

Taxonomy

Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
71013601A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71013601A
IN

Other

Enumeration date
02/17/2023
Last updated
06/01/2023
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