Provider Demographics
NPI:1437843554
Name:EDUN, BANKOLE OLUDARE (HHA)
Entity Type:Individual
Prefix:
First Name:BANKOLE
Middle Name:OLUDARE
Last Name:EDUN
Suffix:
Gender:M
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12404 ROCHINO CT
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9047
Mailing Address - Country:US
Mailing Address - Phone:240-470-2123
Mailing Address - Fax:
Practice Address - Street 1:12404 ROCHINO CT
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9047
Practice Address - Country:US
Practice Address - Phone:240-470-2123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200002651374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide