Healthcare Provider Details

I. General information

NPI: 1801666334
Provider Name (Legal Business Name): ADESOLA I OGUNDOLIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 24TH ST NE # E
WASHINGTON DC
20018-2126
US

IV. Provider business mailing address

19 HOBART CT
RANDALLSTOWN MD
21133-2407
US

V. Phone/Fax

Practice location:
  • Phone: 202-832-8340
  • Fax: 202-832-8340
Mailing address:
  • Phone: 862-600-7058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN500003610
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: