Provider Demographics
NPI:1750939906
Name:LAWAL, TAWAKALITU ABIMBOLA
Entity type:Individual
Prefix:MRS
First Name:TAWAKALITU
Middle Name:ABIMBOLA
Last Name:LAWAL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4241 58TH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-1934
Mailing Address - Country:US
Mailing Address - Phone:240-601-9887
Mailing Address - Fax:
Practice Address - Street 1:7600 GEORGIA AVE NW STE 308
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1616
Practice Address - Country:US
Practice Address - Phone:202-800-9005
Practice Address - Fax:202-248-2044
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-30
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200004805374U00000X
DC950764379374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty