Healthcare Provider Details

I. General information

NPI: 1750228680
Provider Name (Legal Business Name): OMOLARA POPOOLA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

547 RIVERSIDE DR
SALISBURY MD
21801-5369
US

IV. Provider business mailing address

5400 FORDS ENDEAVOR DR
BOWIE MD
20720-3389
US

V. Phone/Fax

Practice location:
  • Phone: 301-351-5495
  • Fax:
Mailing address:
  • Phone: 301-351-5495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR175175
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: