Healthcare Provider Details

I. General information

NPI: 1487285771
Provider Name (Legal Business Name): ANUOLUWAPO OTUYELU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N ST SE BLDG 175 WNY NAVAL BRANCH HEALTH CLINIC
WASHINGTON DC
20374-5162
US

IV. Provider business mailing address

15509 OVERCHASE LN
BOWIE MD
20715-4618
US

V. Phone/Fax

Practice location:
  • Phone: 202-433-6713
  • Fax:
Mailing address:
  • Phone: 301-254-3362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1008264
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: