Healthcare Provider Details

I. General information

NPI: 1417580168
Provider Name (Legal Business Name): TIWALOLA OLABISI AKINSADE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1496 REISTERSTOWN RD STE 220
BALTIMORE MD
21208-3819
US

IV. Provider business mailing address

198 HALPINE RD APT 1426
ROCKVILLE MD
20852-7628
US

V. Phone/Fax

Practice location:
  • Phone: 301-497-1590
  • Fax:
Mailing address:
  • Phone: 202-702-7242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR172396
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: