Provider Demographics
NPI:1477905578
Name:ADARAMOLA, OMOLARA
Entity Type:Individual
Prefix:
First Name:OMOLARA
Middle Name:
Last Name:ADARAMOLA
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 1:3209 RHODE ISLAND AVE APT 24
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-2057
Mailing Address - Country:US
Mailing Address - Phone:240-495-8421
Mailing Address - Fax:
Practice Address - Street 1:3209 RHODE ISLAND AVE APT 24
Practice Address - Street 2:
Practice Address - City:MOUNT RAINIER
Practice Address - State:MD
Practice Address - Zip Code:20712-2057
Practice Address - Country:US
Practice Address - Phone:240-495-8421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12080374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide