Healthcare Provider Details

I. General information

NPI: 1699522854
Provider Name (Legal Business Name): TEMILOLUWA OLUWATOYIN ILESANMI DNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TEMILOLUWA OLUWATOYIN ADEYEHUM DNP, PMHNP-BC

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 ONVILLE RD STE 201
STAFFORD VA
22556-3832
US

IV. Provider business mailing address

15 WHEELWRIGHT LN
STAFFORD VA
22554-8833
US

V. Phone/Fax

Practice location:
  • Phone: 540-698-4259
  • Fax: 540-736-0264
Mailing address:
  • Phone: 307-220-0677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024190104
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP1059632
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAC007655
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: