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General NPI Number Information
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NPI Number | 1629648266
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Entity Type | Individual
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Provider Name | ATILADE A OWOLABI APRN, PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 06/27/2021
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 700 LILLY RD NE
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City | OLYMPIA
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State | WA
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Zip | 98506-5115
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Country | US
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Telephone | 360-923-7000
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Fax | 360-923-7089
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Provider Business Mailing Address
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Address Line | 4570 AVERY LN SE # 9013
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City | LACEY
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State | WA
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Zip | 98503-5608
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP61451208
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License Number State | WA
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