Healthcare Provider Details

I. General information

NPI: 1316156391
Provider Name (Legal Business Name): OLANIRETI ONABANJO NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 SANTIAGO RD STE 109
COLUMBIA MD
21045-3958
US

IV. Provider business mailing address

9650 SANTIAGO RD STE 109
COLUMBIA MD
21045-3958
US

V. Phone/Fax

Practice location:
  • Phone: 240-732-1009
  • Fax: 240-755-0102
Mailing address:
  • Phone: 240-732-1009
  • Fax: 240-755-0102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR208320
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR208320
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR208320
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024179218
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: