Healthcare Provider Details

I. General information

NPI: 1396005104
Provider Name (Legal Business Name): BILIKISU A KEHINDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 05/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10412 VISTA GARDENS DR
BOWIE MD
20720-4238
US

IV. Provider business mailing address

10412 VISTA GARDENS DR
BOWIE MD
20720-4238
US

V. Phone/Fax

Practice location:
  • Phone: 240-778-7714
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: