MEDICARE: MRS. BUKOLA OLUWATOYIN OLAJIDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	NA08774052	TX
2	164W00000X	Licensed Practical Nurse	340183	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NA08774052	OTHER	TX	TEXAS NURSE AIDE REGISTRY

General Provider Information

NPI Number	:	1922378835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BUKOLA OLUWATOYIN OLAJIDE

Provider Business Mailing Address
First Line	:	1508 PARKWAY LN
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76010-5958
Country	:	US
Telephone Number	:	214-400-8683
Fax Number	:

Provider Business Practice Location Address
First Line	:	1508 PARKWAY LN
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76010-5958
Country	:	US
Telephone Number	:	214-400-8683
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2012
Last Update Date	:	10/27/2017

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