Provider Demographics
NPI:1295374221
Name:OLADELE, OLUSHOLA
Entity Type:Individual
Prefix:MISS
First Name:OLUSHOLA
Middle Name:
Last Name:OLADELE
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 1:9526 WESTERDALE DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2455
Mailing Address - Country:US
Mailing Address - Phone:301-910-6377
Mailing Address - Fax:
Practice Address - Street 1:1328 SOUTHERN AVE SE STE 205
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4689
Practice Address - Country:US
Practice Address - Phone:240-230-7090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-20
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR214571363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily