Provider Demographics
NPI:1619428638
Name:FASINA, OLUWAFUNMBI
Entity Type:Individual
Prefix:
First Name:OLUWAFUNMBI
Middle Name:
Last Name:FASINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 FARAWAY CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1824
Mailing Address - Country:US
Mailing Address - Phone:240-838-9392
Mailing Address - Fax:
Practice Address - Street 1:4265 58TH AVE
Practice Address - Street 2:APT T1
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-1922
Practice Address - Country:US
Practice Address - Phone:240-838-9392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-14
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12346374U00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide