Provider Demographics
NPI:1245119486
Name:OMOYELE, MONISOLA RACHAEL
Entity type:Individual
Prefix:
First Name:MONISOLA
Middle Name:RACHAEL
Last Name:OMOYELE
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 1:18692 LEXINGTON
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-1941
Mailing Address - Country:US
Mailing Address - Phone:734-419-3394
Mailing Address - Fax:
Practice Address - Street 1:18692 LEXINGTON
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-1941
Practice Address - Country:US
Practice Address - Phone:734-419-3394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI000011901376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty