Provider Demographics
NPI:1578922969
Name:JIMOH-MAKANJUOLA, OLUFUNMILAYO
Entity Type:Individual
Prefix:
First Name:OLUFUNMILAYO
Middle Name:
Last Name:JIMOH-MAKANJUOLA
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 1:7 SUTTON CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1424
Mailing Address - Country:US
Mailing Address - Phone:240-696-9738
Mailing Address - Fax:
Practice Address - Street 1:7 SUTTON CT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1424
Practice Address - Country:US
Practice Address - Phone:240-696-9738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
MDCNA - A00134302251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide