Healthcare Provider Details

I. General information

NPI: 1841732815
Provider Name (Legal Business Name): PAULINE OLUWO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8118 GOOD LUCK RD
LANHAM MD
20706-3574
US

IV. Provider business mailing address

10007 OXBRIDGE WAY
BOWIE MD
20721-2977
US

V. Phone/Fax

Practice location:
  • Phone: 240-241-7474
  • Fax: 301-241-5733
Mailing address:
  • Phone: 301-370-2462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR154021
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: