Provider Demographics
NPI:1356609242
Name:OLAYIWOLA, OMOLOLA ANIFAT
Entity type:Individual
Prefix:
First Name:OMOLOLA
Middle Name:ANIFAT
Last Name:OLAYIWOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OMOLOLA
Other - Middle Name:
Other - Last Name:AKALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13201 FALLING WATER CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3271
Mailing Address - Country:US
Mailing Address - Phone:301-302-6567
Mailing Address - Fax:
Practice Address - Street 1:2312 RHODE ISLAND AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-2829
Practice Address - Country:US
Practice Address - Phone:202-635-6006
Practice Address - Fax:202-636-1936
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide