Provider Demographics
NPI:1871858704
Name:ALEBIOSU, OLUDOLAPO HENRIETTA
Entity type:Individual
Prefix:
First Name:OLUDOLAPO
Middle Name:HENRIETTA
Last Name:ALEBIOSU
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:OLUDOLAPO
Other - Middle Name:
Other - Last Name:AYOKANMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3444 LINDEN GROVE DR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4041
Mailing Address - Country:US
Mailing Address - Phone:301-979-1227
Mailing Address - Fax:
Practice Address - Street 1:3444 LINDEN GROVE DR
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4041
Practice Address - Country:US
Practice Address - Phone:301-979-1227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR221362363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health