Provider Demographics
NPI:1205483096
Name:AKINFOLARIN, OMOLARA ATINUKE
Entity type:Individual
Prefix:
First Name:OMOLARA
Middle Name:ATINUKE
Last Name:AKINFOLARIN
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 1:820 8TH ST APT 201
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-3945
Mailing Address - Country:US
Mailing Address - Phone:240-714-1967
Mailing Address - Fax:
Practice Address - Street 1:820 8TH ST APT 201
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3945
Practice Address - Country:US
Practice Address - Phone:240-714-1967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14643374U00000X, 374U00000X
251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251B00000XAgenciesCase Management