Healthcare Provider Details

I. General information

NPI: 1518659911
Provider Name (Legal Business Name): TAWAKALITU OLANREWAJU DNP, PMHNP, FNP, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1934 OLD GALLOWS RD STE 322
VIENNA VA
22182-4042
US

IV. Provider business mailing address

1934 OLD GALLOWS RD STE 322
VIENNA VA
22182-4042
US

V. Phone/Fax

Practice location:
  • Phone: 703-947-0672
  • Fax: 703-843-9601
Mailing address:
  • Phone: 703-947-0672
  • Fax: 703-843-9601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024191010
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR128252
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: