Provider Demographics
NPI:1699522854
Name:ILESANMI, TEMILOLUWA OLUWATOYIN (PMHNP)
Entity type:Individual
Prefix:
First Name:TEMILOLUWA
Middle Name:OLUWATOYIN
Last Name:ILESANMI
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:TEMILOLUWA
Other - Middle Name:OLUWATOYIN
Other - Last Name:ADEYEHUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 WHEELWRIGHT LN
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-8833
Mailing Address - Country:US
Mailing Address - Phone:307-220-0677
Mailing Address - Fax:
Practice Address - Street 1:1818 NEW YORK AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1848
Practice Address - Country:US
Practice Address - Phone:202-800-6440
Practice Address - Fax:202-899-6994
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNP1059632363LP0808X
VA0024190104363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty