Provider Demographics
NPI:1093356321
Name:BANKOLE, OLAMIDE IYANU
Entity Type:Individual
Prefix:
First Name:OLAMIDE
Middle Name:IYANU
Last Name:BANKOLE
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 1:20 CAROL AVE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-3502
Mailing Address - Country:US
Mailing Address - Phone:443-210-5377
Mailing Address - Fax:
Practice Address - Street 1:20 CAROL AVE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-3502
Practice Address - Country:US
Practice Address - Phone:443-210-5377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide