Provider Demographics
NPI:1033476684
Name:OLUSI, NIMOTA Y
Entity Type:Individual
Prefix:
First Name:NIMOTA
Middle Name:Y
Last Name:OLUSI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9502 MUIRKIRK RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2751
Mailing Address - Country:US
Mailing Address - Phone:240-704-0631
Mailing Address - Fax:
Practice Address - Street 1:9502 MUIRKIRK RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-2751
Practice Address - Country:US
Practice Address - Phone:240-704-0631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide