Provider Demographics
NPI:1194976258
Name:ADEBOWALE, WALEOLA
Entity type:Individual
Prefix:
First Name:WALEOLA
Middle Name:
Last Name:ADEBOWALE
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 1:17639 TRINITY MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-1987
Mailing Address - Country:US
Mailing Address - Phone:240-486-3494
Mailing Address - Fax:
Practice Address - Street 1:18438 AUSTIN OAK LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-2276
Practice Address - Country:US
Practice Address - Phone:240-486-3494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX08231968376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide