MEDICARE: GBEMISOLA OPEOLUWA OLARINRE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1-180749	AL

General Provider Information

NPI Number	:	1407699432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GBEMISOLA OPEOLUWA OLARINRE

Provider Business Mailing Address
First Line	:	301 BROWN SPRINGS RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-7005
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4385 NARROW LANE RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-2978
Country	:	US
Telephone Number	:	334-747-3116
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2024
Last Update Date	:	08/26/2025

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