Healthcare Provider Details

I. General information

NPI: 1881394773
Provider Name (Legal Business Name): YETUNDE OLAMIDE OLOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 EASTERN AVE
BALTIMORE MD
21224-4108
US

IV. Provider business mailing address

7121 YAMHILL WAY
GLEN BURNIE MD
21060-8727
US

V. Phone/Fax

Practice location:
  • Phone: 667-239-2977
  • Fax:
Mailing address:
  • Phone: 667-239-2977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR241382
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: