Provider Demographics
NPI:1679086813
Name:OBATUASE, ABIOLA OLAKITAN (NP)
Entity type:Individual
Prefix:MRS
First Name:ABIOLA
Middle Name:OLAKITAN
Last Name:OBATUASE
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15212 TORINO WAY
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:MD
Mailing Address - Zip Code:21797-9485
Mailing Address - Country:US
Mailing Address - Phone:410-800-4572
Mailing Address - Fax:410-286-1923
Practice Address - Street 1:3350 WILKENS AVE STE 302
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-4618
Practice Address - Country:US
Practice Address - Phone:443-722-0954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR174133363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily