Provider Demographics
NPI:1891361150
Name:OLUADE, MOBOLAJI DADA
Entity Type:Individual
Prefix:
First Name:MOBOLAJI
Middle Name:DADA
Last Name:OLUADE
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 1:2404 FERDINAND DR
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-7457
Mailing Address - Country:US
Mailing Address - Phone:919-559-6056
Mailing Address - Fax:
Practice Address - Street 1:2015 VILLAGE PARK DR
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-7041
Practice Address - Country:US
Practice Address - Phone:919-559-6056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC6018253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care