Provider Demographics
NPI:1891576062
Name:OLORUNFEMI, ABAYOMI OLUMIDE
Entity Type:Individual
Prefix:
First Name:ABAYOMI
Middle Name:OLUMIDE
Last Name:OLORUNFEMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 SCOTCH PINE DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2789
Mailing Address - Country:US
Mailing Address - Phone:240-486-1573
Mailing Address - Fax:
Practice Address - Street 1:1615 SCOTCH PINE DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-2789
Practice Address - Country:US
Practice Address - Phone:240-486-1573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1039130163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse