Provider Demographics
NPI:1790291136
Name:AYANRU, OLADUNNI
Entity Type:Individual
Prefix:
First Name:OLADUNNI
Middle Name:
Last Name:AYANRU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OLADUNNI
Other - Middle Name:S
Other - Last Name:OLAYINKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:703-722-5840
Mailing Address - Fax:703-327-4491
Practice Address - Street 1:15195 HEATHCOTE BLVD STE 140
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-6243
Practice Address - Country:US
Practice Address - Phone:571-284-4370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-21
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175591363L00000X, 363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care