Provider Demographics
NPI:1730669722
Name:ADEOYE SHOWOLE, DORCAS ADEYOSOLA (RN)
Entity Type:Individual
Prefix:MRS
First Name:DORCAS
Middle Name:ADEYOSOLA
Last Name:ADEOYE SHOWOLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 W PACIFIC COAST HWY APT 118
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-1875
Mailing Address - Country:US
Mailing Address - Phone:310-947-9381
Mailing Address - Fax:
Practice Address - Street 1:1623 W PACIFIC COAST HWY APT 118
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-1875
Practice Address - Country:US
Practice Address - Phone:310-947-9381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-19
Last Update Date:2018-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA596210163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse