Healthcare Provider Details

I. General information

NPI: 1639738578
Provider Name (Legal Business Name): BISOLA GRACE OLORUNFEMI DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8612 GLENARDEN PKWY
GLENARDEN MD
20706-1522
US

IV. Provider business mailing address

8612 GLENARDEN PKWY
GLENARDEN MD
20706-1522
US

V. Phone/Fax

Practice location:
  • Phone: 240-815-2258
  • Fax:
Mailing address:
  • Phone: 240-815-2258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA14486
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberHHA14486
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: