Provider Demographics
NPI:1235479304
Name:BANK OLE, OLUWASEUN B
Entity Type:Individual
Prefix:
First Name:OLUWASEUN
Middle Name:B
Last Name:BANK OLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5636 WHITFIELD CHAPEL RD APT 302
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2556
Mailing Address - Country:US
Mailing Address - Phone:609-481-1048
Mailing Address - Fax:
Practice Address - Street 1:5636 WHITFIELD CHAPEL RD APT 302
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2556
Practice Address - Country:US
Practice Address - Phone:609-481-1048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC37400000X374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide