Provider Demographics
NPI:1437765625
Name:OGUNLOLU, JAMES OLAJIDE
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:OLAJIDE
Last Name:OGUNLOLU
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 1:9302 WYATT DR
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2442
Mailing Address - Country:US
Mailing Address - Phone:202-297-9002
Mailing Address - Fax:
Practice Address - Street 1:9302 WYATT DR
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2442
Practice Address - Country:US
Practice Address - Phone:202-297-9002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA15364374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide