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General NPI Number Information
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NPI Number | 1164743233
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Entity Type | Individual
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Provider Name | WEMIMO FEYISAYO OLAGBAJU NP
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Gender | Female
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Dates
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Enumeration Date | 06/11/2010
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Last Update Date | 03/26/2021
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Provider Practice Location Address
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Address Line | 301 N AZUSA AVE
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City | WEST COVINA
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State | CA
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Zip | 91791-1346
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Country | US
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Telephone | 562-359-6782
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Fax |
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Provider Business Mailing Address
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Address Line | 3601 ODONNELL ST
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City | BALTIMORE
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State | MD
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Zip | 21224-5238
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN965471
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R141437
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License Number State | MD
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