Healthcare Provider Details

I. General information

NPI: 1588149520
Provider Name (Legal Business Name): WALE J OJEYINKA NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4209 QUANDERS PROMISE DR
BOWIE MD
20720-4693
US

IV. Provider business mailing address

4209 QUANDERS PROMISE DR
BOWIE MD
20720-4693
US

V. Phone/Fax

Practice location:
  • Phone: 301-877-5677
  • Fax: 301-877-5680
Mailing address:
  • Phone: 240-603-7675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR198104
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN1018367
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: