Provider Demographics
NPI:1093495251
Name:OGUNNIYI, BILIKIS
Entity Type:Individual
Prefix:
First Name:BILIKIS
Middle Name:
Last Name:OGUNNIYI
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 1:661 LAKEMONT DR
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-8793
Mailing Address - Country:US
Mailing Address - Phone:410-979-2452
Mailing Address - Fax:
Practice Address - Street 1:711 W 40TH ST STE 438
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2199
Practice Address - Country:US
Practice Address - Phone:410-243-8632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR225900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner