Provider Demographics
NPI:1265190805
Name:AKINYEMI, OLUMIDE ANTHONY (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MR
First Name:OLUMIDE
Middle Name:ANTHONY
Last Name:AKINYEMI
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11093 S W MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:VA
Mailing Address - Zip Code:22427
Mailing Address - Country:US
Mailing Address - Phone:804-633-0043
Mailing Address - Fax:
Practice Address - Street 1:3149 W SPRINGS DR APT F
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-2952
Practice Address - Country:US
Practice Address - Phone:443-570-3452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR183165163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2021105176OtherAMERICAN NURSES CREDENTIALING CENTER
MDR183165OtherMARYLAND BOARD OF NURSING