Provider Demographics
NPI:1225702970
Name:OSADOLOR, OLABISI ENITAN
Entity Type:Individual
Prefix:
First Name:OLABISI ENITAN
Middle Name:
Last Name:OSADOLOR
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 1:6337 LANDOVER RD APT 102
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1337
Mailing Address - Country:US
Mailing Address - Phone:240-877-6232
Mailing Address - Fax:
Practice Address - Street 1:6337 LANDOVER RD APT 102
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1337
Practice Address - Country:US
Practice Address - Phone:240-877-6232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide