Provider Demographics
NPI:1144772328
Name:LUKULA, OLUFOLAKE (NP)
Entity Type:Individual
Prefix:
First Name:OLUFOLAKE
Middle Name:
Last Name:LUKULA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:OLUFOLAKE
Other - Middle Name:
Other - Last Name:OGUNDIRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13601 MARY BOWIE PKWY
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-9075
Mailing Address - Country:US
Mailing Address - Phone:240-350-7575
Mailing Address - Fax:
Practice Address - Street 1:613 HAMMONDS LN
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MD
Practice Address - Zip Code:21225-3351
Practice Address - Country:US
Practice Address - Phone:410-636-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR198113363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04624315Medicaid
MD219284500Medicaid
NYJ400350091-GRPBA0017Medicare PIN