Provider Demographics
NPI:1013156181
Name:ADISA, OLUWATOYIN CLARA (ACNP)
Entity Type:Individual
Prefix:MRS
First Name:OLUWATOYIN
Middle Name:CLARA
Last Name:ADISA
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:MRS
Other - First Name:OLUWATOYIN
Other - Middle Name:CLARA
Other - Last Name:ADISA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ACNP
Mailing Address - Street 1:4534 OLD COURT RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-2430
Mailing Address - Country:US
Mailing Address - Phone:443-629-2282
Mailing Address - Fax:
Practice Address - Street 1:3425 SINCLAIR LN
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-2030
Practice Address - Country:US
Practice Address - Phone:410-366-1151
Practice Address - Fax:410-366-1151
Is Sole Proprietor?:No
Enumeration Date:2009-02-13
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171618363LA2100X
DCRN68175363LA2100X
MDR142566363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care