Provider Demographics
NPI:1326705757
Name:FATOLU, FOLAKE ZAINAB
Entity Type:Individual
Prefix:
First Name:FOLAKE
Middle Name:ZAINAB
Last Name:FATOLU
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 1:9103 MIDLAND TURN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-5315
Mailing Address - Country:US
Mailing Address - Phone:240-524-6295
Mailing Address - Fax:
Practice Address - Street 1:9103 MIDLAND TURN
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-5315
Practice Address - Country:US
Practice Address - Phone:240-524-6295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
MDA00190444376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide