Provider Demographics
NPI:1639895444
Name:ALABA, FOLASADE FAWEHINMI (PMHNP)
Entity type:Individual
Prefix:
First Name:FOLASADE
Middle Name:FAWEHINMI
Last Name:ALABA
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10709 VISTA GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4253
Mailing Address - Country:US
Mailing Address - Phone:240-988-4619
Mailing Address - Fax:
Practice Address - Street 1:10709 VISTA GARDENS DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-4253
Practice Address - Country:US
Practice Address - Phone:240-988-4619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR225288363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health