Provider Demographics
NPI:1003224106
Name:OLODUN, MAURYN
Entity Type:Individual
Prefix:
First Name:MAURYN
Middle Name:
Last Name:OLODUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 KANSAS AVE NE
Mailing Address - Street 2:NORTHWEST
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-1531
Mailing Address - Country:US
Mailing Address - Phone:202-772-7776
Mailing Address - Fax:
Practice Address - Street 1:6120 KANSAS AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-1531
Practice Address - Country:US
Practice Address - Phone:202-722-7776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN961688163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health