Provider Demographics
NPI:1124451059
Name:OLUSEGUN, ROTIMI SAMSUNG
Entity type:Individual
Prefix:
First Name:ROTIMI
Middle Name:SAMSUNG
Last Name:OLUSEGUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10095 WASHINGTON BLVD N APT 313
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1952
Mailing Address - Country:US
Mailing Address - Phone:301-982-6477
Mailing Address - Fax:
Practice Address - Street 1:10095 WASHINGTON BLVD N APT 313
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-1952
Practice Address - Country:US
Practice Address - Phone:301-982-6477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide