Provider Demographics
NPI:1619239704
Name:MOSUNLADE, WALEOLA
Entity Type:Individual
Prefix:
First Name:WALEOLA
Middle Name:
Last Name:MOSUNLADE
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 1:1907 MARYLAND AVE NE APT 104
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3126
Mailing Address - Country:US
Mailing Address - Phone:202-705-5118
Mailing Address - Fax:
Practice Address - Street 1:1907 MARYLAND AVE NE APT 104
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3126
Practice Address - Country:US
Practice Address - Phone:202-705-5118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
DCHHA4045374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide