MEDICARE: MRS. ATINUKE OLUFUNSO OSUNDINA AGACNP-BC

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	363LA2100X	Acute Care Nurse Practitioner	R219500	MD

General Provider Information

NPI Number	:	1518502244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ATINUKE OLUFUNSO OSUNDINA AGACNP-BC

Provider Business Mailing Address
First Line	:	7215 SUGAR MAGNOLIA LN
Second Line	:
City	:	ELKRIDGE
State	:	MD
Zip	:	21075-2401
Country	:	US
Telephone Number	:	347-445-4149
Fax Number	:

Provider Business Practice Location Address
First Line	:	7215 SUGAR MAGNOLIA LN
Second Line	:
City	:	ELKRIDGE
State	:	MD
Zip	:	21075-2401
Country	:	US
Telephone Number	:	347-445-4149
Fax Number	:

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

Provider Enumeration Date	:	11/18/2019
Last Update Date	:	11/18/2019

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