Provider Demographics
NPI:1932971819
Name:IGE, BOLAJOKO (CNA)
Entity Type:Individual
Prefix:
First Name:BOLAJOKO
Middle Name:
Last Name:IGE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 PEPPER CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-7186
Mailing Address - Country:US
Mailing Address - Phone:470-406-1126
Mailing Address - Fax:
Practice Address - Street 1:2602 PEPPER CT
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-7186
Practice Address - Country:US
Practice Address - Phone:470-406-1126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0030089114376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide