Provider Demographics
NPI:1568227726
Name:RAHEEM, SAKIRAT BUKOLA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SAKIRAT
Middle Name:BUKOLA
Last Name:RAHEEM
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8217 APPALACHIAN DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-1167
Mailing Address - Country:US
Mailing Address - Phone:202-718-8653
Mailing Address - Fax:
Practice Address - Street 1:7131 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:GWYNN OAK
Practice Address - State:MD
Practice Address - Zip Code:21207-4575
Practice Address - Country:US
Practice Address - Phone:443-200-5338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR196979363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily