Healthcare Provider Details

I. General information

NPI: 1124459995
Provider Name (Legal Business Name): FOLUKE OGUNKUNLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2013
Last Update Date: 12/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 BRIGHTSEAT RD APT 301
LANDOVER MD
20785-3525
US

IV. Provider business mailing address

2240 BRIGHTSEAT RD APT 301
LANDOVER MD
20785-3525
US

V. Phone/Fax

Practice location:
  • Phone: 832-561-7840
  • Fax:
Mailing address:
  • Phone: 832-561-7840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA5407
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: