MEDICARE: WALEOLA ADEBOWALE

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	376K00000X	Nurse's Aide	08231968	TX

General Provider Information

NPI Number	:	1194976258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALEOLA ADEBOWALE

Provider Business Mailing Address
First Line	:	17639 TRINITY MEADOW LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-1987
Country	:	US
Telephone Number	:	240-486-3494
Fax Number	:

Provider Business Practice Location Address
First Line	:	18438 AUSTIN OAK LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-2276
Country	:	US
Telephone Number	:	240-486-3494
Fax Number	:

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

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	10/08/2008

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Directions to “ WALEOLA ADEBOWALE ” Practice Location

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