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General NPI Number Information
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NPI Number | 1821705930
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Entity Type | Organization
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Legal Business Name | BOWIE PSYCHIATRIC PROFESSIONAL ASSOCIATE LLC
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Dates
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Enumeration Date | 10/31/2022
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 1007 KINGS HEATHER DR
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City | BOWIE
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State | MD
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Zip | 20721-2010
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Country | US
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Telephone | 301-648-9340
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Fax | 301-218-1090
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Provider Business Mailing Address
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Address Line | 1007 KINGS HEATHER DR
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City | BOWIE
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State | MD
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Zip | 20721-2010
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Country | US
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Telephone | 301-648-9340
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Fax | 301-218-1090
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Authorized Official
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Title or Position | CEO
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Name | OLAOLU FADAIRO
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Credential | NP
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Telephone | 301-648-9340
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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 |
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License Number State |
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