Individual
OLAKUNLE IDRIS AYANWALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
13020 LAUREL BOWIE RD APT 201, LAUREL, MD 20708-2131
(240) 486-1560
Mailing address
13020 LAUREL BOWIE RD APT 201, LAUREL, MD 20708-2131
(240) 486-1560
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R220724
MD
163W00000X
Registered Nurse
RN1040614
DC
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R220724
MD
Other
Enumeration date
05/18/2016
Last updated
08/08/2023
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