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NPI Code Detail

MEDICARE: OLUWASEYI LADIPUPO SOETAN PMHNP - BC

MEDICARE: OLUWASEYI LADIPUPO SOETAN PMHNP - BC
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner0024180400VA

General Provider Information

NPI Number : 1932701984
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLUWASEYI LADIPUPO SOETAN PMHNP - BC
Provider Business Mailing Address
First Line : 5706 GOSSAMER CT
Second Line :
City : MOSELEY
State : VA
Zip : 23120-2339
Country : US
Telephone Number : 540-204-2459
Fax Number :
Provider Business Practice Location Address
First Line : 26317 WASHINGTON ST
Second Line :
City : NORTH DINWIDDIE
State : VA
Zip : 23803-2727
Country : US
Telephone Number : 540-204-2459
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2020
Last Update Date : 04/30/2024

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