Provider Demographics
NPI:1619763554
Name:AWONUGA, OLUFEMI
Entity type:Individual
Prefix:
First Name:OLUFEMI
Middle Name:
Last Name:AWONUGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2266 CANTEEN CIR
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1083
Mailing Address - Country:US
Mailing Address - Phone:240-714-8795
Mailing Address - Fax:
Practice Address - Street 1:2266 CANTEEN CIR
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1083
Practice Address - Country:US
Practice Address - Phone:240-714-8795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN500020426164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse