Provider Demographics
NPI:1467008441
Name:OLUWOLE, ELIZABETH TEMITOPE
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:TEMITOPE
Last Name:OLUWOLE
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 1:11823 CHANERA AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-1825
Mailing Address - Country:US
Mailing Address - Phone:661-448-7091
Mailing Address - Fax:
Practice Address - Street 1:11823 CHANERA AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-1825
Practice Address - Country:US
Practice Address - Phone:661-448-7091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010653363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily