Provider Demographics
NPI:1508380940
Name:OMILANA, FUNMILOLA OLAMIDE I (HHA)
Entity Type:Individual
Prefix:MS
First Name:FUNMILOLA
Middle Name:OLAMIDE
Last Name:OMILANA
Suffix:I
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:FUNMILOLA
Other - Middle Name:OLAMIDE
Other - Last Name:OMILANA
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:HHA
Mailing Address - Street 1:865 21ST ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4134
Mailing Address - Country:US
Mailing Address - Phone:202-386-0861
Mailing Address - Fax:
Practice Address - Street 1:865 21ST ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4134
Practice Address - Country:US
Practice Address - Phone:202-386-0861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-27
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
DCHHA12831374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide