Provider Demographics
NPI:1053892422
Name:OYIBOKE, JUSTINA
Entity type:Individual
Prefix:
First Name:JUSTINA
Middle Name:
Last Name:OYIBOKE
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 1:2307 RIVER LODGE LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-8983
Mailing Address - Country:US
Mailing Address - Phone:832-513-8881
Mailing Address - Fax:
Practice Address - Street 1:2307 RIVER LODGE LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-8983
Practice Address - Country:US
Practice Address - Phone:832-513-8881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX136961164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse