Provider Demographics
NPI:1114457421
Name:IKUOMOLA, OLOLADE (NP-C)
Entity Type:Individual
Prefix:
First Name:OLOLADE
Middle Name:
Last Name:IKUOMOLA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 MACE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21221-3315
Mailing Address - Country:US
Mailing Address - Phone:410-391-6996
Mailing Address - Fax:410-687-6877
Practice Address - Street 1:1124 MACE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221-3315
Practice Address - Country:US
Practice Address - Phone:410-391-6996
Practice Address - Fax:410-687-6877
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR201929363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care