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General NPI Number Information
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NPI Number | 1669953071
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Entity Type | Individual
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Provider Name | OLUBUNMI OLAIDE OLAWALE
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Gender | Female
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Dates
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Enumeration Date | 08/23/2018
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 21 MAYOR THOMAS J MCGRATH HWY STE 306
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City | QUINCY
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State | MA
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Zip | 02169-5351
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Country | US
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Telephone | 781-742-0834
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Fax | 781-459-2666
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Provider Business Mailing Address
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Address Line | 21 MAYOR THOMAS J MCGRATH HWY STE 306
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City | QUINCY
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State | MA
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Zip | 02169-5351
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Country | US
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Telephone | 781-742-0834
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Fax | 781-459-2666
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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 | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number | RN2264640
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN2264640
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License Number State | MA
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