Provider Demographics
NPI:1063079879
Name:SABA, BOLANLE (APRN FNP-C)
Entity type:Individual
Prefix:MS
First Name:BOLANLE
Middle Name:
Last Name:SABA
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7855 SOMERSET CT
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3025
Mailing Address - Country:US
Mailing Address - Phone:301-741-5828
Mailing Address - Fax:
Practice Address - Street 1:111 CENTERWAY STE C2
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1808
Practice Address - Country:US
Practice Address - Phone:240-670-4050
Practice Address - Fax:240-201-2660
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR213551363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily