Provider Demographics
NPI:1306190871
Name:FAMORIYO, OMOLOLA OLUBUNMI
Entity Type:Individual
Prefix:
First Name:OMOLOLA
Middle Name:OLUBUNMI
Last Name:FAMORIYO
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 1:3925 GEORGIA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-5860
Mailing Address - Country:US
Mailing Address - Phone:240-485-8839
Mailing Address - Fax:
Practice Address - Street 1:2901 VALERIAN LN
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-9215
Practice Address - Country:US
Practice Address - Phone:240-485-8839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMT0077871163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health