MEDICARE: OLUWASOLA TALE CNA

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	164W00000X	Licensed Practical Nurse	LPN50002706	DC
2	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1588146971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUWASOLA TALE CNA

Provider Business Mailing Address
First Line	:	2262 RUBY TURN
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20721-1897
Country	:	US
Telephone Number	:	240-696-9987
Fax Number	:

Provider Business Practice Location Address
First Line	:	2262 RUBY TURN
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20721-1897
Country	:	US
Telephone Number	:	240-696-9987
Fax Number	:

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

Provider Enumeration Date	:	08/31/2018
Last Update Date	:	12/19/2025

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