Provider Demographics
NPI:1477259786
Name:WALLER, MOROLAYO OLAJUMOKE (CNM)
Entity Type:Individual
Prefix:
First Name:MOROLAYO
Middle Name:OLAJUMOKE
Last Name:WALLER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:MOROLAYO
Other - Middle Name:OLAJUMOKE
Other - Last Name:OLAOFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7026 ARNOLD AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:JBER
Mailing Address - State:AK
Mailing Address - Zip Code:99506-1126
Mailing Address - Country:US
Mailing Address - Phone:631-469-8453
Mailing Address - Fax:
Practice Address - Street 1:4001 LAKE OTIS PKWY STE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5200
Practice Address - Country:US
Practice Address - Phone:800-769-0045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife