Healthcare Provider Details

I. General information

NPI: 1194590869
Provider Name (Legal Business Name): ILENE O ADEMOLA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2023
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 FREDERICK RD STE 258
CATONSVILLE MD
21228-4668
US

IV. Provider business mailing address

405 FREDERICK RD STE 258
CATONSVILLE MD
21228-4668
US

V. Phone/Fax

Practice location:
  • Phone: 443-876-9058
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN218247
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: