Individual
OLANREWAJU OLUDOTUN ONIFADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
VA, DC, MD
Contact information
Practice address
75 FENWOOD RD, BOSTON, MA 02115-6103
(617) 626-9703
(617) 626-9703
Mailing address
24017 AUDUBON TRAIL DR, ALDIE, VA 20105-5921
(571) 218-5326
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN2372522
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0024182548
—
VA
Enumeration date
08/30/2021
Last updated
12/07/2023
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