Provider Demographics
NPI:1689351744
Name:ADEBUSOYE, OLUSHOLA O
Entity Type:Individual
Prefix:
First Name:OLUSHOLA
Middle Name:O
Last Name:ADEBUSOYE
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 1:9419 3RD ST N
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1803
Mailing Address - Country:US
Mailing Address - Phone:240-693-6991
Mailing Address - Fax:
Practice Address - Street 1:9419 3RD ST N
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-1803
Practice Address - Country:US
Practice Address - Phone:240-593-6991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN009257163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health