Provider Demographics
NPI:1154152940
Name:ONIFADE, TOLULASE (PMHNP, MSN, BSN, RN)
Entity type:Individual
Prefix:
First Name:TOLULASE
Middle Name:
Last Name:ONIFADE
Suffix:
Gender:F
Credentials:PMHNP, MSN, BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44121 HARRY BYRD HIGHWAY
Mailing Address - Street 2:SUITE 275
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5671
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44121 HARRY BYRD HIGHWAY
Practice Address - Street 2:SUITE 275
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5671
Practice Address - Country:US
Practice Address - Phone:571-510-0016
Practice Address - Fax:866-422-2128
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024190928363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health