Provider Demographics
NPI:1477259786
Name:WALLER, MOROLAYO OLAJUMOKE (CNM)
Entity type:Individual
Prefix:
First Name:MOROLAYO
Middle Name:OLAJUMOKE
Last Name:WALLER
Suffix:
Gender:
Credentials:CNM
Other - Prefix:
Other - First Name:MOROLAYO
Other - Middle Name:OLAJUMOKE
Other - Last Name:OLAOFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1548 RUTLAND WAY
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1729
Mailing Address - Country:US
Mailing Address - Phone:631-469-8453
Mailing Address - Fax:
Practice Address - Street 1:8501 LASALLE ROAD
Practice Address - Street 2:SUITE 309
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286
Practice Address - Country:US
Practice Address - Phone:410-576-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK202012367A00000X
MDR269993367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife