Provider Demographics
NPI:1083243372
Name:ADEWALE, OLAMIDE ADETORO
Entity Type:Individual
Prefix:
First Name:OLAMIDE
Middle Name:ADETORO
Last Name:ADEWALE
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 1:3031 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-1339
Mailing Address - Country:US
Mailing Address - Phone:509-230-2384
Mailing Address - Fax:
Practice Address - Street 1:3031 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-1339
Practice Address - Country:US
Practice Address - Phone:509-230-2384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60034807163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse