Healthcare Provider Details

I. General information

NPI: 1932961778
Provider Name (Legal Business Name): REMILEKUN RUTH ADEMOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 EMMORTON RD STE 2A
ABINGDON MD
21009-2587
US

IV. Provider business mailing address

3105 EMMORTON RD STE 2A
ABINGDON MD
21009-2587
US

V. Phone/Fax

Practice location:
  • Phone: 443-653-8152
  • Fax: 404-973-2947
Mailing address:
  • Phone: 443-653-8152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR245083
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: