Healthcare Provider Details

I. General information

NPI: 1063325223
Provider Name (Legal Business Name): JUMOKE O BOLAJI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUMOKE OMOLAYO AKINDOJU

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 FRONT ST
BEREA OH
44017-1943
US

IV. Provider business mailing address

7212 BOULDER WOOD DR
BROADVIEW HEIGHTS OH
44147-2267
US

V. Phone/Fax

Practice location:
  • Phone: 440-243-4000
  • Fax: 440-234-0819
Mailing address:
  • Phone: 614-316-3881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95409696
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number544405
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: