Healthcare Provider Details

I. General information

NPI: 1972054831
Provider Name (Legal Business Name): OLUYEMISI OGUNYEMI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2016
Last Update Date: 10/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8007 RACE HORSE LN
BOWIE MD
20715-3302
US

IV. Provider business mailing address

8007 RACE HORSE LN
BOWIE MD
20715-3302
US

V. Phone/Fax

Practice location:
  • Phone: 443-618-4436
  • Fax:
Mailing address:
  • Phone: 443-618-4436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR116590
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: