Provider Demographics
NPI:1699316414
Name:AKPARANTA, MARY OLUBUKOLA
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:OLUBUKOLA
Last Name:AKPARANTA
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 1:8317 HAWKSRIDGE DR SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98513-1714
Mailing Address - Country:US
Mailing Address - Phone:206-639-1196
Mailing Address - Fax:
Practice Address - Street 1:8317 HAWKSRIDGE DR SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98513-1714
Practice Address - Country:US
Practice Address - Phone:206-639-1196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide