Provider Demographics
NPI:1528431459
Name:AKINTUNDE, MONISOLA BOLANLE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:MONISOLA
Middle Name:BOLANLE
Last Name:AKINTUNDE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:BOLANLE
Other - Middle Name:OMOLABAKE
Other - Last Name:AKINTUNDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:202 NOB HILL WAY
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-3905
Mailing Address - Country:US
Mailing Address - Phone:301-672-7360
Mailing Address - Fax:
Practice Address - Street 1:7556 TEAGUE RD STE 112
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1969
Practice Address - Country:US
Practice Address - Phone:410-514-6041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR187106363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily