Provider Demographics
NPI:1073491106
Name:OGUNGBILE, OMOLOLA OLUWASEUN (CRNP)
Entity type:Individual
Prefix:
First Name:OMOLOLA
Middle Name:OLUWASEUN
Last Name:OGUNGBILE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7736 ROTHERHAM DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1460
Mailing Address - Country:US
Mailing Address - Phone:410-841-9998
Mailing Address - Fax:410-841-9998
Practice Address - Street 1:8015 APPLE VALLEY DR
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-4174
Practice Address - Country:US
Practice Address - Phone:410-841-9998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR191701363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner