Healthcare Provider Details

I. General information

NPI: 1609497577
Provider Name (Legal Business Name): OLUWAFUNSO E PHILLIPS REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2020
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1949 4TH ST NE
WASHINGTON DC
20002-1211
US

IV. Provider business mailing address

276 HARRY S TRUMAN DR
UPPER MARLBORO MD
20774-2021
US

V. Phone/Fax

Practice location:
  • Phone: 202-462-7500
  • Fax:
Mailing address:
  • Phone: 301-213-1133
  • Fax: 301-350-3678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN1054621
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: