Provider Demographics
NPI:1629439948
Name:OGUNMAKINWA, OLUKEMI B (CRNP)
Entity Type:Individual
Prefix:
First Name:OLUKEMI
Middle Name:B
Last Name:OGUNMAKINWA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18566 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-0587
Mailing Address - Country:US
Mailing Address - Phone:301-769-6640
Mailing Address - Fax:301-769-6640
Practice Address - Street 1:18566 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-0587
Practice Address - Country:US
Practice Address - Phone:301-769-6640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR159264363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily