Individual
MR. STEPHEN OLOMUKORO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5401 OLD COURT RD, RANDALLSTOWN, MD 21133-5103
(410) 521-2200
Mailing address
11781 LEE JACKSON MEMORIAL HWY, SUITE 550, FAIRFAX, VA 22033-3309
(571) 777-5157
(703) 890-2650
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R152983
MD
367500000X
Certified Registered Nurse Anesthetist
Primary
R152983
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
030075600
—
MD
Enumeration date
12/16/2009
Last updated
04/25/2019
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