Provider Demographics
NPI:1437872363
Name:MOLOKWU, BUKOLA
Entity Type:Individual
Prefix:
First Name:BUKOLA
Middle Name:
Last Name:MOLOKWU
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 1:1011 ROSEMERE AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-3008
Mailing Address - Country:US
Mailing Address - Phone:202-489-2700
Mailing Address - Fax:301-345-2999
Practice Address - Street 1:1011 ROSEMERE AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-3008
Practice Address - Country:US
Practice Address - Phone:202-489-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR174436163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse