Provider Demographics
NPI:1831961432
Name:OLAJUYIGBE, BOLANLE
Entity type:Individual
Prefix:
First Name:BOLANLE
Middle Name:
Last Name:OLAJUYIGBE
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 1:2 W ROLLING XRDS
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-6211
Mailing Address - Country:US
Mailing Address - Phone:443-538-3629
Mailing Address - Fax:
Practice Address - Street 1:2 W ROLLING XRDS
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-6211
Practice Address - Country:US
Practice Address - Phone:443-538-3629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR163958363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health