Provider Demographics
NPI:1376352179
Name:ISHOLA, HERBERT ABIFOLA
Entity type:Individual
Prefix:
First Name:HERBERT
Middle Name:ABIFOLA
Last Name:ISHOLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 BRIGHTSEAT RD APT 6
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-3554
Mailing Address - Country:US
Mailing Address - Phone:312-792-5583
Mailing Address - Fax:
Practice Address - Street 1:2314 BRIGHTSEAT RD APT 6
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-3554
Practice Address - Country:US
Practice Address - Phone:312-792-5583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200004569374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide