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General NPI Number Information
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NPI Number | 1356944136
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Entity Type | Individual
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Provider Name | BOLATITO A OWOLABI
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Gender | Female
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Dates
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Enumeration Date | 11/16/2020
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Last Update Date | 05/18/2021
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Provider Practice Location Address
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Address Line | 15624 N PLATTE DR
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City | BOWIE
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State | MD
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Zip | 20716-1361
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Country | US
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Telephone | 124-069-5412
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Fax |
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Provider Business Mailing Address
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Address Line | 15624 N PLATTE DR
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City | BOWIE
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State | MD
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Zip | 20716-1361
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Country | US
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Telephone | 240-695-4128
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | RN1034864
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License Number State | DC
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