Provider Demographics
NPI:1013474238
Name:VINCENT, OLAMIDE ABIODUN
Entity Type:Individual
Prefix:
First Name:OLAMIDE
Middle Name:ABIODUN
Last Name:VINCENT
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 1:5215 CONCORD PIKE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-1416
Mailing Address - Country:US
Mailing Address - Phone:484-408-5168
Mailing Address - Fax:877-383-8544
Practice Address - Street 1:5215 CONCORD PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-1416
Practice Address - Country:US
Practice Address - Phone:484-408-5168
Practice Address - Fax:877-383-8544
Is Sole Proprietor?:No
Enumeration Date:2019-02-24
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG0001239363LF0000X
PASP019995363LF0000X
DEL8-0010349363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily