Provider Demographics
NPI:1568011104
Name:BAMGBELU, FOLASADE ADETOKUNBO
Entity Type:Individual
Prefix:
First Name:FOLASADE
Middle Name:ADETOKUNBO
Last Name:BAMGBELU
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 1:6813 STRAUSS
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-1480
Mailing Address - Country:US
Mailing Address - Phone:303-564-0889
Mailing Address - Fax:
Practice Address - Street 1:6813 STRAUSS
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-1480
Practice Address - Country:US
Practice Address - Phone:303-564-0889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX906572163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health