Provider Demographics
NPI:1396433389
Name:JIMOH, BUSOLA R (LPN)
Entity type:Individual
Prefix:MRS
First Name:BUSOLA
Middle Name:R
Last Name:JIMOH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15119 19TH PL W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-8764
Mailing Address - Country:US
Mailing Address - Phone:425-418-1732
Mailing Address - Fax:
Practice Address - Street 1:8831 CORBIN DR
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-7149
Practice Address - Country:US
Practice Address - Phone:425-418-1732
Practice Address - Fax:425-582-8161
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00048251164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse