MEDICARE: OLUWABUNMI OLUWAYINKA

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	R194545	MD

General Provider Information

NPI Number	:	1811402209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUWABUNMI OLUWAYINKA

Provider Business Mailing Address
First Line	:	3813 BAYONNE AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21206-3406
Country	:	US
Telephone Number	:	443-421-8230
Fax Number	:

Provider Business Practice Location Address
First Line	:	3813 BAYONNE AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21206-3406
Country	:	US
Telephone Number	:	443-421-8230
Fax Number	:

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

Provider Enumeration Date	:	12/06/2017
Last Update Date	:	11/27/2020

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