MEDICARE: MRS. ABIDEMI OLUWADAMILOLA OLA 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
1	363LF0000X	Family Nurse Practitioner	R187401	MD

General Provider Information

NPI Number	:	1548719511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ABIDEMI OLUWADAMILOLA OLA CRNP

Provider Business Mailing Address
First Line	:	4606 HOLMEHURST WAY
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-3461
Country	:	US
Telephone Number	:	240-485-7730
Fax Number	:

Provider Business Practice Location Address
First Line	:	4606 HOLMEHURST WAY
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-3461
Country	:	US
Telephone Number	:	240-485-7730
Fax Number	:

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

Provider Enumeration Date	:	09/30/2016
Last Update Date	:	09/30/2016

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