Provider Demographics
NPI:1083979389
Name:ADEGOKE, ROSELINE OMOSOLAPE (HOME HEALTH AIDE)
Entity Type:Individual
Prefix:
First Name:ROSELINE
Middle Name:OMOSOLAPE
Last Name:ADEGOKE
Suffix:
Gender:F
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6139 64TH AVE
Mailing Address - Street 2:APT. 3
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-2930
Mailing Address - Country:US
Mailing Address - Phone:301-979-2002
Mailing Address - Fax:
Practice Address - Street 1:6139 64TH AVE
Practice Address - Street 2:APT. 3
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-2930
Practice Address - Country:US
Practice Address - Phone:301-979-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide