Provider Demographics
NPI:1548770720
Name:ADEDAPO, OLUREMI OLUFISOLA (NP)
Entity Type:Individual
Prefix:
First Name:OLUREMI
Middle Name:OLUFISOLA
Last Name:ADEDAPO
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 1:3412A CARROLL AVE
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-3917
Mailing Address - Country:US
Mailing Address - Phone:443-286-5401
Mailing Address - Fax:
Practice Address - Street 1:3412A CARROLL AVE
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-3917
Practice Address - Country:US
Practice Address - Phone:443-286-5401
Practice Address - Fax:443-405-3514
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR169785363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily