Healthcare Provider Details

I. General information

NPI: 1932967254
Provider Name (Legal Business Name): OLAJUMOKE O OGUNFIDITIMI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3413 OLANDWOOD CT
OLNEY MD
20832-1489
US

IV. Provider business mailing address

3413 OLANDWOOD CT
OLNEY MD
20832-1489
US

V. Phone/Fax

Practice location:
  • Phone: 240-786-1001
  • Fax:
Mailing address:
  • Phone: 240-786-1001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR226377
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: