Healthcare Provider Details

I. General information

NPI: 1760315287
Provider Name (Legal Business Name): MRS. OLUWAYEMISI K LAWAL- AGBOOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 N 60TH ST
MILWAUKEE WI
53218-3260
US

IV. Provider business mailing address

5353 N 60TH ST
MILWAUKEE WI
53218-3260
US

V. Phone/Fax

Practice location:
  • Phone: 773-814-8569
  • Fax:
Mailing address:
  • Phone: 773-814-8569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: