Healthcare Provider Details

I. General information

NPI: 1639783616
Provider Name (Legal Business Name): OLABISI OLAYIWOLA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2020
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13108 MANOR DR
MOUNT AIRY MD
21771-4506
US

IV. Provider business mailing address

13108 MANOR DR
MOUNT AIRY MD
21771-4506
US

V. Phone/Fax

Practice location:
  • Phone: 773-829-3787
  • Fax:
Mailing address:
  • Phone: 773-829-3787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2026015682
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: