Provider Demographics
NPI:1952949133
Name:AKINWANDE, OMOLARA OMOLABAKE
Entity Type:Individual
Prefix:
First Name:OMOLARA
Middle Name:OMOLABAKE
Last Name:AKINWANDE
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 1:11215 GEORGIA AVE APT 602
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-4662
Mailing Address - Country:US
Mailing Address - Phone:240-701-3700
Mailing Address - Fax:
Practice Address - Street 1:KBC NURSING AGENCY
Practice Address - Street 2:7506 GEORGIA AVE NW WASHINGTON DC
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-2001
Practice Address - Country:US
Practice Address - Phone:202-291-6976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN965864163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse