Provider Demographics
NPI:1417346784
Name:LAWAL, IDIAT I
Entity Type:Individual
Prefix:
First Name:IDIAT
Middle Name:
Last Name:LAWAL
Suffix:I
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 1:4219 58TH AVE
Mailing Address - Street 2:#2
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-1942
Mailing Address - Country:US
Mailing Address - Phone:301-949-0466
Mailing Address - Fax:301-933-2007
Practice Address - Street 1:1416 9TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-3344
Practice Address - Country:US
Practice Address - Phone:202-483-9111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide