Provider Demographics
NPI:1770935330
Name:ALAGBADA, FOLASADE BOLANLE (MHA, MSN, BSN, RN)
Entity type:Individual
Prefix:
First Name:FOLASADE
Middle Name:BOLANLE
Last Name:ALAGBADA
Suffix:
Gender:F
Credentials:MHA, MSN, BSN, RN
Other - Prefix:
Other - First Name:FOLASADE
Other - Middle Name:ALAGBADA
Other - Last Name:ALABI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:43825 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2551
Mailing Address - Country:US
Mailing Address - Phone:734-397-3088
Mailing Address - Fax:
Practice Address - Street 1:43825 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-2551
Practice Address - Country:US
Practice Address - Phone:734-397-3088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704284236163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health