Healthcare Provider Details

I. General information

NPI: 1003224106
Provider Name (Legal Business Name): MAURYN OLODUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 08/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6120 KANSAS AVE NE
WASHINGTON DC
20011-1531
US

IV. Provider business mailing address

6120 KANSAS AVE NE NORTHWEST
WASHINGTON DC
20011-1531
US

V. Phone/Fax

Practice location:
  • Phone: 202-722-7776
  • Fax:
Mailing address:
  • Phone: 202-772-7776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN961688
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: