Provider Demographics
NPI:1023814209
Name:BAMIDELE, OYINDAMOLA GLORY
Entity type:Individual
Prefix:
First Name:OYINDAMOLA
Middle Name:GLORY
Last Name:BAMIDELE
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 1:10823 187TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-8938
Mailing Address - Country:US
Mailing Address - Phone:915-201-8457
Mailing Address - Fax:
Practice Address - Street 1:10823 187TH STREET CT E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-8938
Practice Address - Country:US
Practice Address - Phone:915-201-8457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN24108524246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy