Provider Demographics
NPI:1518707108
Name:LAWAL BANKOLE, DAMILOLA
Entity type:Individual
Prefix:
First Name:DAMILOLA
Middle Name:
Last Name:LAWAL BANKOLE
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 1:13852 N HAWKERS HILL DR
Mailing Address - Street 2:
Mailing Address - City:CAMBY
Mailing Address - State:IN
Mailing Address - Zip Code:46113-8029
Mailing Address - Country:US
Mailing Address - Phone:317-801-4519
Mailing Address - Fax:
Practice Address - Street 1:13852 N HAWKERS HILL DR
Practice Address - Street 2:
Practice Address - City:CAMBY
Practice Address - State:IN
Practice Address - Zip Code:46113-8029
Practice Address - Country:US
Practice Address - Phone:317-801-4519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant