Healthcare Provider Details

I. General information

NPI: 1376907105
Provider Name (Legal Business Name): SHAKIRAT ADEBOLA BANKOLE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 VANDERCAR WAY
CINCINNATI OH
45209-7542
US

IV. Provider business mailing address

12900 PARK PLAZA DR STE 150
CERRITOS CA
90703-9329
US

V. Phone/Fax

Practice location:
  • Phone: 937-424-2215
  • Fax:
Mailing address:
  • Phone: 657-309-1619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.18909
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: