Provider Demographics
NPI:1811256845
Name:SOWOLE, JOKE
Entity type:Individual
Prefix:
First Name:JOKE
Middle Name:
Last Name:SOWOLE
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 1:3831 PENNSYLVANIA AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-1309
Mailing Address - Country:US
Mailing Address - Phone:202-853-4879
Mailing Address - Fax:202-575-1001
Practice Address - Street 1:3831 PENNSYLVANIA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-1309
Practice Address - Country:US
Practice Address - Phone:202-853-4879
Practice Address - Fax:202-575-1001
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
DC171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide