Healthcare Provider Details

I. General information

NPI: 1578922969
Provider Name (Legal Business Name): OLUFUNMILAYO JIMOH-MAKANJUOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 SUTTON CT
UPPER MARLBORO MD
20774-1424
US

IV. Provider business mailing address

7 SUTTON CT
UPPER MARLBORO MD
20774-1424
US

V. Phone/Fax

Practice location:
  • Phone: 240-696-9738
  • Fax:
Mailing address:
  • Phone: 240-696-9738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberCNA - A00134302
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: