Provider Demographics
NPI:1720613839
Name:AKINOLA, OLASEGE BRIDGET
Entity Type:Individual
Prefix:
First Name:OLASEGE
Middle Name:BRIDGET
Last Name:AKINOLA
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 1:1746 VILLAGE GREEN DR
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4161
Mailing Address - Country:US
Mailing Address - Phone:240-918-2578
Mailing Address - Fax:
Practice Address - Street 1:1746 VILLAGE GREEN DR
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-4161
Practice Address - Country:US
Practice Address - Phone:240-918-2578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA254660098477OtherSTATE IDENTIFICATION