Provider Demographics
NPI:1497115422
Name:ADEKANMI, OMOLARA
Entity Type:Individual
Prefix:
First Name:OMOLARA
Middle Name:
Last Name:ADEKANMI
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 1:1835 CEDARWOOD CT
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4003
Mailing Address - Country:US
Mailing Address - Phone:301-318-8180
Mailing Address - Fax:
Practice Address - Street 1:1835 CEDARWOOD CT
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-4003
Practice Address - Country:US
Practice Address - Phone:301-318-8180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1006657164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse