Healthcare Provider Details

I. General information

NPI: 1679086813
Provider Name (Legal Business Name): ABIOLA OLAKITAN OBATUASE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 WILKENS AVE STE 302
BALTIMORE MD
21229-4618
US

IV. Provider business mailing address

15212 TORINO WAY
WOODBINE MD
21797-9485
US

V. Phone/Fax

Practice location:
  • Phone: 443-722-0954
  • Fax:
Mailing address:
  • Phone: 410-800-4572
  • Fax: 410-286-1923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR174133
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: