Provider Demographics
NPI:1861136285
Name:AKINLOSOTU, DORIS OMOSHALEWA (RN)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:OMOSHALEWA
Last Name:AKINLOSOTU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DORIS
Other - Middle Name:OMOSHALEWA
Other - Last Name:AKINLOSOTU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SHALEWA AKINWANDE
Mailing Address - Street 1:24437 RUSSELL RD STE 108
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-1786
Mailing Address - Country:US
Mailing Address - Phone:206-228-9990
Mailing Address - Fax:
Practice Address - Street 1:24860 PACIFIC HWY S STE 201
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5401
Practice Address - Country:US
Practice Address - Phone:206-228-9990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA24860Medicaid