Provider Demographics
NPI:1457744781
Name:ADEMOLA, BOLUDE
Entity Type:Individual
Prefix:MRS
First Name:BOLUDE
Middle Name:
Last Name:ADEMOLA
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 1:6312 INWOOD ST
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-3132
Mailing Address - Country:US
Mailing Address - Phone:240-755-5103
Mailing Address - Fax:
Practice Address - Street 1:6856 EASTERN AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-2165
Practice Address - Country:US
Practice Address - Phone:202-545-6980
Practice Address - Fax:877-839-6747
Is Sole Proprietor?:No
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1003743374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide