Healthcare Provider Details

I. General information

NPI: 1629648266
Provider Name (Legal Business Name): ATILADE A OWOLABI APRN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2021
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LILLY RD NE
OLYMPIA WA
98506-5115
US

IV. Provider business mailing address

4570 AVERY LN SE # 9013
LACEY WA
98503-5608
US

V. Phone/Fax

Practice location:
  • Phone: 360-923-7000
  • Fax: 360-923-7089
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61451208
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: