Healthcare Provider Details

I. General information

NPI: 1093340267
Provider Name (Legal Business Name): OLUWATOYIN OMOLA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 NEW YORK AVE NE
WASHINGTON DC
20002-1848
US

IV. Provider business mailing address

1818 NEW YORK AVE NE STE 115
WASHINGTON DC
20002-1851
US

V. Phone/Fax

Practice location:
  • Phone: 202-269-2401
  • Fax:
Mailing address:
  • Phone: 202-269-2401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN1029040
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN1029040
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: