Provider Demographics
NPI:1891164158
Name:ADEWOLE, TEMILADE ADEBANGBE
Entity Type:Individual
Prefix:
First Name:TEMILADE
Middle Name:ADEBANGBE
Last Name:ADEWOLE
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 1:3819 64TH AVE
Mailing Address - Street 2:APT. # 3
Mailing Address - City:LANDOVER HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1826
Mailing Address - Country:US
Mailing Address - Phone:240-355-1632
Mailing Address - Fax:
Practice Address - Street 1:3819 64TH AVE
Practice Address - Street 2:APT. # 3
Practice Address - City:LANDOVER HILLS
Practice Address - State:MD
Practice Address - Zip Code:20784-1826
Practice Address - Country:US
Practice Address - Phone:240-355-1632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide