Provider Demographics
NPI:1902371883
Name:TOMIYE, OLAIDE OLUFUNMILAY
Entity Type:Individual
Prefix:
First Name:OLAIDE
Middle Name:OLUFUNMILAY
Last Name:TOMIYE
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 1:9211 GARY LN
Mailing Address - Street 2:
Mailing Address - City:GLENARDEN
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2603
Mailing Address - Country:US
Mailing Address - Phone:240-906-0408
Mailing Address - Fax:
Practice Address - Street 1:9211 GARY LN
Practice Address - Street 2:
Practice Address - City:GLENARDEN
Practice Address - State:MD
Practice Address - Zip Code:20774-2603
Practice Address - Country:US
Practice Address - Phone:240-906-0408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13948374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide