Healthcare Provider Details

I. General information

NPI: 1891543195
Provider Name (Legal Business Name): YETUNDE ODOLE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10320 LITTLE PATUXENT PKWY STE 200
COLUMBIA MD
21044-3344
US

IV. Provider business mailing address

10320 LITTLE PATUXENT PKWY STE 200
COLUMBIA MD
21044-3344
US

V. Phone/Fax

Practice location:
  • Phone: 410-977-2847
  • Fax: 888-744-3418
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR235388
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1050909
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: