Provider Demographics
NPI:1730914698
Name:AYOLE, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:AYOLE
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 1:3300 YELLOW FLOWER RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-3201
Mailing Address - Country:US
Mailing Address - Phone:940-594-7521
Mailing Address - Fax:
Practice Address - Street 1:8319 CHERRY LN STE 1
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4830
Practice Address - Country:US
Practice Address - Phone:240-551-8055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00186369374700000X
MT0090937374700000X
MDT2W3R8F7374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician