MEDICARE: GRACE OMOLADUN AKINTOLA

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	163WH0200X	Home Health Registered Nurse	1043400	TX

General Provider Information

NPI Number	:	1962255877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE OMOLADUN AKINTOLA

Provider Business Mailing Address
First Line	:	811 TWIN EDGE DR
Second Line	:
City	:	ROYSE CITY
State	:	TX
Zip	:	75189-8814
Country	:	US
Telephone Number	:	971-331-3847
Fax Number	:

Provider Business Practice Location Address
First Line	:	811 TWIN EDGE DR
Second Line	:
City	:	ROYSE CITY
State	:	TX
Zip	:	75189-8814
Country	:	US
Telephone Number	:	971-331-3847
Fax Number	:

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

Provider Enumeration Date	:	04/09/2024
Last Update Date	:	04/09/2024

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