Healthcare Provider Details

I. General information

NPI: 1255695839
Provider Name (Legal Business Name): OLUSEYI OGUNJUYIGBE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 EAGLES NEST DR
BOWIE MD
20716-3905
US

IV. Provider business mailing address

2909 EAGLES NEST DR
BOWIE MD
20716-3905
US

V. Phone/Fax

Practice location:
  • Phone: 301-357-5432
  • Fax:
Mailing address:
  • Phone: 301-357-5432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1005451
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: