Basic Information
| Provider Information | |||||||||
| NPI: | 1518047380 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LASEKAN | ||||||||
| FirstName: | BOSEDE | ||||||||
| MiddleName: | DELEOLA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | CNM | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | OGUNWALE | ||||||||
| OtherFirstName: | BOSEDE | ||||||||
| OtherMiddleName: | DELEOLA | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | CNM | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6295 LEAFY SCREEN | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210454510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103095787 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3001 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | CHEVERLY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207851189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016182355 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 04/11/2008 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | F001094-1 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | R139747 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.