Provider Demographics
NPI:1508317249
Name:OLAWUYI, OLUWAKEMI (NP)
Entity Type:Individual
Prefix:
First Name:OLUWAKEMI
Middle Name:
Last Name:OLAWUYI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22611-1340
Mailing Address - Country:US
Mailing Address - Phone:240-382-2401
Mailing Address - Fax:949-449-7561
Practice Address - Street 1:1 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:VA
Practice Address - Zip Code:22611-1340
Practice Address - Country:US
Practice Address - Phone:240-382-2401
Practice Address - Fax:949-449-7561
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRN182653363LF0000X
MDACOO3284363LP0808X
VA0024175186363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily