Provider Demographics
NPI:1659926475
Name:OLORUNSOLA, AANU ELIZABETH
Entity Type:Individual
Prefix:MRS
First Name:AANU
Middle Name:ELIZABETH
Last Name:OLORUNSOLA
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 1:2319B MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5010
Mailing Address - Country:US
Mailing Address - Phone:443-759-5955
Mailing Address - Fax:
Practice Address - Street 1:2319B MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5010
Practice Address - Country:US
Practice Address - Phone:443-759-5955
Practice Address - Fax:443-438-7809
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR210530363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health