Provider Demographics
NPI:1457839003
Name:OLAFUSI, OLUWAFUNBI
Entity Type:Individual
Prefix:
First Name:OLUWAFUNBI
Middle Name:
Last Name:OLAFUSI
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 1:5337 85TH AVE APT 13
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3207
Mailing Address - Country:US
Mailing Address - Phone:240-467-0427
Mailing Address - Fax:
Practice Address - Street 1:5337 85TH AVE APT 13
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784
Practice Address - Country:US
Practice Address - Phone:240-467-0427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-04
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDO412660021599OtherAGENCY