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General NPI Number Information
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NPI Number | 1093513236
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Entity Type | Individual
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Provider Name | OLUBOLA TOMILOLA ADESUYI
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Gender | Female
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Dates
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Enumeration Date | 03/04/2025
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 8609 WESTWOOD CENTER DR STE 110
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City | VIENNA
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State | VA
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Zip | 22182-7525
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Country | US
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Telephone | 703-722-4828
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Fax |
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Provider Business Mailing Address
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Address Line | 12751 FAIR LAKES CIRCLE APT 403
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City | FAIRFAX
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State | VA
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Zip | 22033
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Country | US
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Telephone | 509-339-4456
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 24192768
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License Number State | VA
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