Mutiat Ayobamidele Olukoga, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

12357 Issued in MN

Practice address

6805 Cattail CT S
Cottage Grove, MN 55016-1722

Phone

(651) 239-0617

NPI assigned

Dec 17, 2024

Last updated

Dec 17, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Theoria Medical

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1609362375

  MN

  Medicare reassignment NPD
• Theoria Medical

  dba Theoria Primary Care

  • Internal Medicine Physician
  • Brighton, MI
  • NPI 1164186946
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1734393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734393600000",
    "number": "1902613417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6805 CATTAIL CT S",
            "city": "COTTAGE GROVE",
            "state": "MN",
            "postal_code": "550161722",
            "telephone_number": "651-239-0617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6805 CATTAIL CT S",
            "city": "COTTAGE GROVE",
            "state": "MN",
            "postal_code": "550161722",
            "telephone_number": "651-239-0617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLUKOGA",
        "first_name": "MUTIAT",
        "middle_name": "AYOBAMIDELE",
        "name_prefix": "Dr.",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-12-17",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "12357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ebosetale Odiaogbe Okoruwa, DDS
• Robyn C Oliver, MD
• Lindsey Patricia Olsen
• David A. Olson, MD
• Jennifer Olszewski
• On the Go Chiropractic LLC
• On the Move Therapy & Wellness
• Optical Services Direct LLC
• Optometric Physicians LLC
• Felicia Lashawn Palmer

• Family Nurse Practitioner in Cottage Grove, MN
• Providers in Cottage Grove, MN by specialty
• Family Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.