Healthcare Provider Details

I. General information

NPI: 1467890855
Provider Name (Legal Business Name): ADEOLA OLOTU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1232 RACE ROAD STE 403
ROSEDALE MD
21237
US

IV. Provider business mailing address

1232 RACE ROAD STE 403
ROSEDALE MD
21237
US

V. Phone/Fax

Practice location:
  • Phone: 443-868-7101
  • Fax: 443-732-0054
Mailing address:
  • Phone: 443-868-7101
  • Fax: 443-732-0054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR174288
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR174288
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR174288
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: