Provider Demographics
NPI:1184498362
Name:OKUSANYA, ADETINUKE OLUWATOYIN (CRNP-PMH)
Entity type:Individual
Prefix:
First Name:ADETINUKE
Middle Name:OLUWATOYIN
Last Name:OKUSANYA
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8403 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-4527
Mailing Address - Country:US
Mailing Address - Phone:240-280-6918
Mailing Address - Fax:
Practice Address - Street 1:8403 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4527
Practice Address - Country:US
Practice Address - Phone:240-280-6918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR226406364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health