Provider Demographics
NPI:1508538570
Name:DIRISU, TOLULOPE F
Entity Type:Individual
Prefix:
First Name:TOLULOPE
Middle Name:F
Last Name:DIRISU
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 1:5802 ANNAPOLIS RD
Mailing Address - Street 2:APT 203
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710
Mailing Address - Country:US
Mailing Address - Phone:202-840-3655
Mailing Address - Fax:
Practice Address - Street 1:5802 ANNAPOLIS RD
Practice Address - Street 2:APT 203
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710
Practice Address - Country:US
Practice Address - Phone:301-202-6375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide