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General NPI Number Information
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NPI Number | 1669280293
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Entity Type | Individual
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Provider Name | BOLUWAJI IYIOLA
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Gender | Female
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Dates
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Enumeration Date | 12/30/2024
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 4102 SHORE DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-2608
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Country | US
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Telephone | 317-597-2117
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Fax |
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Provider Business Mailing Address
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Address Line | 4008 RADLEY CT
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City | DANVILLE
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State | IN
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Zip | 46122-9179
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Country | US
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Telephone | 309-203-6902
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 71016263A
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License Number State | IN
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