Provider Demographics
NPI:1922378835
Name:OLAJIDE, BUKOLA OLUWATOYIN
Entity Type:Individual
Prefix:MRS
First Name:BUKOLA
Middle Name:OLUWATOYIN
Last Name:OLAJIDE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BUKOLA
Other - Middle Name:O
Other - Last Name:AKINSETE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1508 PARKWAY LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-5958
Mailing Address - Country:US
Mailing Address - Phone:214-400-8683
Mailing Address - Fax:
Practice Address - Street 1:1508 PARKWAY LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-5958
Practice Address - Country:US
Practice Address - Phone:214-400-8683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA08774052376K00000X
TX340183164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNA08774052OtherTEXAS NURSE AIDE REGISTRY