Provider Demographics
NPI:1386227155
Name:ADENIRAN, RITA K
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:K
Last Name:ADENIRAN
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 1:1230 AGNEW DR
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-1810
Mailing Address - Country:US
Mailing Address - Phone:215-573-6036
Mailing Address - Fax:
Practice Address - Street 1:1230 BURMONT RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-4504
Practice Address - Country:US
Practice Address - Phone:610-513-7587
Practice Address - Fax:610-449-1175
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN312491L163WC1500X, 163WC1600X, 163WH0200X, 163W00000X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101540673Medicaid