Provider Demographics
NPI:1982119376
Name:OLANREWAJU, OYEBISI IFEOLUWA-ENIOLA
Entity Type:Individual
Prefix:
First Name:OYEBISI
Middle Name:IFEOLUWA-ENIOLA
Last Name:OLANREWAJU
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 1:14804 PHYSICIANS LN STE 121
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3912
Mailing Address - Country:US
Mailing Address - Phone:301-610-6630
Mailing Address - Fax:
Practice Address - Street 1:14804 PHYSICIANS LN STE 121
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3912
Practice Address - Country:US
Practice Address - Phone:301-610-6630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC002131363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily