Provider Demographics
NPI:1275874034
Name:OLANIYAN, OLAJUMOKE OLADIPO
Entity Type:Individual
Prefix:MRS
First Name:OLAJUMOKE
Middle Name:OLADIPO
Last Name:OLANIYAN
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 1:5006 70TH AVE
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1516
Mailing Address - Country:US
Mailing Address - Phone:240-643-7209
Mailing Address - Fax:301-431-0706
Practice Address - Street 1:5006 70TH AVE
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-1516
Practice Address - Country:US
Practice Address - Phone:240-643-7209
Practice Address - Fax:301-431-0706
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDMT0069830OtherMEDICATION TECHNICIAN