Provider Demographics
NPI:1881267433
Name:AINA, OLUBUKOLA A I (CRNP-ADULT)
Entity type:Individual
Prefix:DR
First Name:OLUBUKOLA
Middle Name:A
Last Name:AINA
Suffix:I
Gender:F
Credentials:CRNP-ADULT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29 S GREENE ST STE 319
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1504
Mailing Address - Country:US
Mailing Address - Phone:667-214-1734
Mailing Address - Fax:410-706-6976
Practice Address - Street 1:419 W REDWOOD ST STE 300
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-7003
Practice Address - Country:US
Practice Address - Phone:667-214-1718
Practice Address - Fax:410-328-5147
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR181982208G00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health