Provider Demographics
NPI:1669249199
Name:GBOLABO, OLUWATOYIN FUNKE
Entity type:Individual
Prefix:MRS
First Name:OLUWATOYIN
Middle Name:FUNKE
Last Name:GBOLABO
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 1:708 STONE MESA CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-8328
Mailing Address - Country:US
Mailing Address - Phone:817-217-3457
Mailing Address - Fax:
Practice Address - Street 1:708 STONE MESA CT
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-8328
Practice Address - Country:US
Practice Address - Phone:817-217-3457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No374U00000XNursing Service Related ProvidersHome Health Aide