MEDICARE: FOLASHADE OLUBUKOLA LONGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant	000000	WI

General Provider Information

NPI Number	:	1033935135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FOLASHADE OLUBUKOLA LONGE

Provider Business Mailing Address
First Line	:	5070 N 23RD ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-5661
Country	:	US
Telephone Number	:	414-238-5341
Fax Number	:

Provider Business Practice Location Address
First Line	:	5070 N 23RD ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-5661
Country	:	US
Telephone Number	:	414-238-5341
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2024
Last Update Date	:	11/23/2024

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Directions to “ FOLASHADE OLUBUKOLA LONGE ” Practice Location

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