Provider Demographics
NPI:1457950206
Name:MAGBAGBEOLA, OLUREMI FLORENCE
Entity Type:Individual
Prefix:
First Name:OLUREMI
Middle Name:FLORENCE
Last Name:MAGBAGBEOLA
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 1:3400 DODGE PARK RD APT 103
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2001
Mailing Address - Country:US
Mailing Address - Phone:240-898-5239
Mailing Address - Fax:
Practice Address - Street 1:3400 DODGE PARK RD APT 103
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-2001
Practice Address - Country:US
Practice Address - Phone:240-898-5239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDHHA15314374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide