Provider Demographics
NPI:1790664035
Name:OLOWU, BABATUNDE SAMUEL (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:BABATUNDE
Middle Name:SAMUEL
Last Name:OLOWU
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1672 S WOODSAGE AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8329
Mailing Address - Country:US
Mailing Address - Phone:208-515-2273
Mailing Address - Fax:208-515-2274
Practice Address - Street 1:1672 S WOODSAGE AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8329
Practice Address - Country:US
Practice Address - Phone:208-515-2273
Practice Address - Fax:208-515-2274
Is Sole Proprietor?:No
Enumeration Date:2025-08-30
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ID6871160363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health