Provider Demographics
NPI:1326451840
Name:EDU, ABISOLA MUTIAT (CNA/HHA)
Entity Type:Individual
Prefix:
First Name:ABISOLA
Middle Name:MUTIAT
Last Name:EDU
Suffix:
Gender:F
Credentials:CNA/HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7755 RIVERDALE RD
Mailing Address - Street 2:APT. 102
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3913
Mailing Address - Country:US
Mailing Address - Phone:301-537-3882
Mailing Address - Fax:
Practice Address - Street 1:7755 RIVERDALE RD
Practice Address - Street 2:APT. 102
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3913
Practice Address - Country:US
Practice Address - Phone:301-537-3882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide