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NPI Code Detail

MEDICARE: OLUSEYI ADEBOLA SOFOLUWE CRNP

MEDICARE: OLUSEYI ADEBOLA SOFOLUWE CRNP
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
1363L00000XNurse PractitionerRN1011899DC
2363L00000XNurse PractitionerR177845MD
3363LA2200XAdult Health Nurse PractitionerR177845MD

General Provider Information

NPI Number : 1518458363
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLUSEYI ADEBOLA SOFOLUWE CRNP
Provider Business Mailing Address
First Line : 7610 CARROLL AVE STE 100
Second Line :
City : TAKOMA PARK
State : MD
Zip : 20912-6311
Country : US
Telephone Number : 301-891-2500
Fax Number :
Provider Business Practice Location Address
First Line : 7610 CARROLL AVE STE 100
Second Line :
City : TAKOMA PARK
State : MD
Zip : 20912-6311
Country : US
Telephone Number : 301-891-2500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2018
Last Update Date : 05/07/2020

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Directions to “ OLUSEYI ADEBOLA SOFOLUWE CRNP” Practice Location

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