Provider Demographics
NPI:1316531353
Name:OLUFOWOBI, OLAWUNMI BOLATITO
Entity type:Individual
Prefix:
First Name:OLAWUNMI
Middle Name:BOLATITO
Last Name:OLUFOWOBI
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 1:10440 LITTLE PATUXENT PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3648
Mailing Address - Country:US
Mailing Address - Phone:240-593-0480
Mailing Address - Fax:301-235-1708
Practice Address - Street 1:10440 LITTLE PATUXENT PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3561
Practice Address - Country:US
Practice Address - Phone:240-593-0480
Practice Address - Fax:301-235-1708
Is Sole Proprietor?:No
Enumeration Date:2021-02-21
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR219346363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health