Provider Demographics
NPI:1689030611
Name:OLADIPUPO, BUKOLA AYOBAMI
Entity Type:Individual
Prefix:
First Name:BUKOLA
Middle Name:AYOBAMI
Last Name:OLADIPUPO
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 1:5636 WHITFIELD CHAPEL RD APT 201
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2556
Mailing Address - Country:US
Mailing Address - Phone:240-938-2969
Mailing Address - Fax:
Practice Address - Street 1:220 I ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4365
Practice Address - Country:US
Practice Address - Phone:202-548-0588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11443374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide