Provider Demographics
NPI:1952179004
Name:AKINOLA, OLATOMI
Entity type:Individual
Prefix:
First Name:OLATOMI
Middle Name:
Last Name:AKINOLA
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 1:10978 BUCKLEY HALL ROAD
Mailing Address - Street 2:
Mailing Address - City:MATHEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23109-2310
Mailing Address - Country:US
Mailing Address - Phone:240-264-9477
Mailing Address - Fax:
Practice Address - Street 1:10978 BUCKLEY HALL ROAD MATHEWS VA 23109
Practice Address - Street 2:
Practice Address - City:MATHEWS
Practice Address - State:VA
Practice Address - Zip Code:23109-2310
Practice Address - Country:US
Practice Address - Phone:804-725-3041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024188782363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health