Provider Demographics
NPI:1063877330
Name:LAWAL, OLAYINKA S (HHA)
Entity type:Individual
Prefix:MRS
First Name:OLAYINKA
Middle Name:S
Last Name:LAWAL
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 LAVENDER LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4284
Mailing Address - Country:US
Mailing Address - Phone:202-394-9920
Mailing Address - Fax:
Practice Address - Street 1:4110 LAVENDER LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-4284
Practice Address - Country:US
Practice Address - Phone:202-394-9920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11663374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD47605029700Medicaid