Provider Demographics
NPI:1487966982
Name:ASOLA-FADOLA, MAURICE (LPN)
Entity type:Individual
Prefix:
First Name:MAURICE
Middle Name:
Last Name:ASOLA-FADOLA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4630 TAMARACK BLVD
Mailing Address - Street 2:APT. C14
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-6582
Mailing Address - Country:US
Mailing Address - Phone:614-843-2991
Mailing Address - Fax:
Practice Address - Street 1:4630 TAMARACK BLVD
Practice Address - Street 2:APT. C14
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-6582
Practice Address - Country:US
Practice Address - Phone:614-843-2991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.137764-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse