Provider Demographics
NPI:1366710444
Name:OLALERE, ODUNLADE (CRNP)
Entity type:Individual
Prefix:MS
First Name:ODUNLADE
Middle Name:
Last Name:OLALERE
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 1:175 W OSTEND ST STE 102
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-3792
Mailing Address - Country:US
Mailing Address - Phone:410-697-5357
Mailing Address - Fax:410-457-9626
Practice Address - Street 1:175 W OSTEND ST STE 102
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-3792
Practice Address - Country:US
Practice Address - Phone:410-697-5357
Practice Address - Fax:410-457-9626
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR170771363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD335165300Medicaid