Provider Demographics
NPI:1649769753
Name:BELLO, OLAWALE
Entity Type:Individual
Prefix:
First Name:OLAWALE
Middle Name:
Last Name:BELLO
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 1:4230 CRUMS MILL RD STE 201
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-2898
Mailing Address - Country:US
Mailing Address - Phone:717-579-4878
Mailing Address - Fax:717-540-1704
Practice Address - Street 1:4230 CRUMS MILL RD STE 201
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112
Practice Address - Country:US
Practice Address - Phone:717-579-4878
Practice Address - Fax:717-540-1704
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN299092164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse