Provider Demographics
NPI:1790124980
Name:ILESANMI, MULIKAT BOLANLE
Entity Type:Individual
Prefix:
First Name:MULIKAT
Middle Name:BOLANLE
Last Name:ILESANMI
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 1:9929 GOOD LUCK RD APT 101
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3258
Mailing Address - Country:US
Mailing Address - Phone:443-449-9538
Mailing Address - Fax:
Practice Address - Street 1:9929 GOOD LUCK RD APT 101
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3258
Practice Address - Country:US
Practice Address - Phone:443-449-9538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1509374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide