Healthcare Provider Details

I. General information

NPI: 1831748664
Provider Name (Legal Business Name): FOLAKE A ADEYEMI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9308 GORDON CT
LAUREL MD
20723-5830
US

IV. Provider business mailing address

9308 GORDON CT
LAUREL MD
20723-5830
US

V. Phone/Fax

Practice location:
  • Phone: 410-746-5704
  • Fax:
Mailing address:
  • Phone: 410-746-5704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberRN1033165
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberR209844
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR209844
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: