Healthcare Provider Details

I. General information

NPI: 1942986641
Provider Name (Legal Business Name): MRS. VICTORIA A OLANIYI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17106 BIRCH LEAF TER
BOWIE MD
20716-3637
US

IV. Provider business mailing address

17106 BIRCH LEAF TER
BOWIE MD
20716-3637
US

V. Phone/Fax

Practice location:
  • Phone: 301-219-5202
  • Fax:
Mailing address:
  • Phone: 301-219-5202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP1013365
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR180887
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1013365
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: