Provider Demographics
NPI:1033363502
Name:OLUTUNDE, ROMOKE M (CNA)
Entity Type:Individual
Prefix:MRS
First Name:ROMOKE
Middle Name:M
Last Name:OLUTUNDE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 SOUTHGATE CT SW STE 205
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-5416
Mailing Address - Country:US
Mailing Address - Phone:319-892-0507
Mailing Address - Fax:319-892-0265
Practice Address - Street 1:3330 SOUTHGATE CT SW STE 205
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-5416
Practice Address - Country:US
Practice Address - Phone:319-892-0507
Practice Address - Fax:319-892-0265
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0400484Medicaid