Provider Demographics
NPI:1265133847
Name:OLAWALE, OLUWATOYIN
Entity type:Individual
Prefix:
First Name:OLUWATOYIN
Middle Name:
Last Name:OLAWALE
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 1:13918 SHANNOCK LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8429
Mailing Address - Country:US
Mailing Address - Phone:301-335-4144
Mailing Address - Fax:
Practice Address - Street 1:2021 CROSS CHURCH WAY
Practice Address - Street 2:
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-2398
Practice Address - Country:US
Practice Address - Phone:301-335-4144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR172508363LF0000X
DCNP1010173363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily