Healthcare Provider Details

I. General information

NPI: 1497272777
Provider Name (Legal Business Name): OLUFEMI OLAWALE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2017
Last Update Date: 08/17/2024
Certification Date: 08/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N ROLLING RD STE 100
WINDSOR MILL MD
21244-1999
US

IV. Provider business mailing address

3507 N ROLLING RD
WINDSOR MILL MD
21244-2203
US

V. Phone/Fax

Practice location:
  • Phone: 443-272-2614
  • Fax: 443-272-2664
Mailing address:
  • Phone: 442-272-2614
  • Fax: 443-272-2664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR182894
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: