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General NPI Number Information
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NPI Number | 1063325223
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Entity Type | Individual
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Provider Name | JUMOKE O BOLAJI
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Gender | Female
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Dates
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Enumeration Date | 09/28/2026
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Last Update Date | 09/28/2026
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Provider Practice Location Address
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Address Line | 255 FRONT ST
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City | BEREA
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State | OH
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Zip | 44017-1943
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Country | US
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Telephone | 440-243-4000
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Fax | 440-234-0819
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Provider Business Mailing Address
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Address Line | 7212 BOULDER WOOD DR
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City | BROADVIEW HEIGHTS
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State | OH
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Zip | 44147-2267
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Country | US
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Telephone | 614-316-3881
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95409696
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 544405
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License Number State | OH
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