MEDICARE: YEKEEN ODEWALE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	R212715	MD
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R212715	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184175697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YEKEEN ODEWALE

Provider Business Mailing Address
First Line	:	5411 OLD FREDERICK RD STE 7
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21229-2126
Country	:	US
Telephone Number	:	410-762-8945
Fax Number	:

Provider Business Practice Location Address
First Line	:	4515 HIDDEN STREAM CT
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-4837
Country	:	US
Telephone Number	:	410-300-6461
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2016
Last Update Date	:	01/30/2025

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Directions to “ YEKEEN ODEWALE ” Practice Location

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