Provider Demographics
NPI:1497462634
Name:OLADIMEJI, TOPE JOSEPHINE
Entity Type:Individual
Prefix:
First Name:TOPE
Middle Name:JOSEPHINE
Last Name:OLADIMEJI
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 1:3624 SPRATLING WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23237-1954
Mailing Address - Country:US
Mailing Address - Phone:501-442-4928
Mailing Address - Fax:
Practice Address - Street 1:26317 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORTH DINWIDDIE
Practice Address - State:VA
Practice Address - Zip Code:23803-2727
Practice Address - Country:US
Practice Address - Phone:804-524-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024185635363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health