Provider Demographics
NPI:1417290214
Name:AIYENUGBA, HANNAH ABIDEMI
Entity Type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:ABIDEMI
Last Name:AIYENUGBA
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 1:6410 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-2819
Mailing Address - Country:US
Mailing Address - Phone:202-341-5296
Mailing Address - Fax:
Practice Address - Street 1:6410 57TH AVE
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-2819
Practice Address - Country:US
Practice Address - Phone:202-341-5296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA136477374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide