Provider Demographics
NPI:1063027027
Name:ABULU, ADESUWA EJEHI
Entity Type:Individual
Prefix:
First Name:ADESUWA
Middle Name:EJEHI
Last Name:ABULU
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 1:3310 PARKFORD MANOR TER APT L
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-6146
Mailing Address - Country:US
Mailing Address - Phone:404-477-8534
Mailing Address - Fax:
Practice Address - Street 1:1315 S ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6925
Practice Address - Country:US
Practice Address - Phone:202-538-1910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00177833376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide