Provider Demographics
NPI:1437478963
Name:AWOLOLA, OLUWADARE OLANIPEKUN (CNA)
Entity Type:Individual
Prefix:
First Name:OLUWADARE
Middle Name:OLANIPEKUN
Last Name:AWOLOLA
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 DRACUT AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06704-2207
Mailing Address - Country:US
Mailing Address - Phone:347-517-5904
Mailing Address - Fax:
Practice Address - Street 1:105 DRACUT AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06704-2207
Practice Address - Country:US
Practice Address - Phone:347-517-5904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTNA9986934376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide