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General NPI Number Information
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NPI Number | 1780397190
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Entity Type | Individual
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Provider Name | OLAKUNLE A ADENUGBA NP
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Gender | Male
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Dates
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Enumeration Date | 12/30/2022
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Last Update Date | 12/30/2022
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Provider Practice Location Address
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Address Line | 3001 S HANOVER ST
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City | BALTIMORE
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State | MD
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Zip | 21225-1233
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Country | US
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Telephone | 410-350-2794
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Fax |
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Provider Business Mailing Address
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Address Line | 3107 FARLEY DR
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City | WINDSOR MILL
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State | MD
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Zip | 21244-2079
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Country | US
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Telephone | 310-728-2428
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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 | R170217
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License Number State | MD
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