Provider Demographics
NPI:1376197566
Name:ODUBENA, ADEBUSOLA BOSE
Entity Type:Individual
Prefix:
First Name:ADEBUSOLA
Middle Name:BOSE
Last Name:ODUBENA
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 1:5026 SILVER HILL CT APT 204
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-2007
Mailing Address - Country:US
Mailing Address - Phone:240-716-8673
Mailing Address - Fax:
Practice Address - Street 1:5026 SILVER HILL CT APT 204
Practice Address - Street 2:
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-2007
Practice Address - Country:US
Practice Address - Phone:240-716-8673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14571374U00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide