Provider Demographics
NPI:1093204232
Name:ADEBISI, OLUBUNMI FADEKE
Entity Type:Individual
Prefix:
First Name:OLUBUNMI
Middle Name:FADEKE
Last Name:ADEBISI
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 1:7511 NEWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3768
Mailing Address - Country:US
Mailing Address - Phone:202-910-3958
Mailing Address - Fax:
Practice Address - Street 1:7511 NEWBERRY LN
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3768
Practice Address - Country:US
Practice Address - Phone:202-910-3958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13458374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide