Provider Demographics
NPI:1851019244
Name:IPEAIYEDA, OLAMIDE M (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:OLAMIDE
Middle Name:M
Last Name:IPEAIYEDA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17320 NEW KENT HWY
Mailing Address - Street 2:
Mailing Address - City:BARHAMSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23011-2353
Mailing Address - Country:US
Mailing Address - Phone:804-652-1120
Mailing Address - Fax:
Practice Address - Street 1:17320 NEW KENT HWY
Practice Address - Street 2:
Practice Address - City:BARHAMSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23011-2353
Practice Address - Country:US
Practice Address - Phone:804-652-1120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024184883363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty