Provider Demographics
NPI:1518047380
Name:LASEKAN, BOSEDE DELEOLA (CNM)
Entity Type:Individual
Prefix:
First Name:BOSEDE
Middle Name:DELEOLA
Last Name:LASEKAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:BOSEDE
Other - Middle Name:DELEOLA
Other - Last Name:OGUNWALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:6295 LEAFY SCREEN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-4510
Mailing Address - Country:US
Mailing Address - Phone:410-309-5787
Mailing Address - Fax:
Practice Address - Street 1:3001 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1189
Practice Address - Country:US
Practice Address - Phone:301-618-2355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001094-1367A00000X
MDR139747367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife