Provider Demographics
NPI:1568628550
Name:OREDERU, ENITAN ADEPEJU (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:ENITAN
Middle Name:ADEPEJU
Last Name:OREDERU
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MRS
Other - First Name:ENITAN
Other - Middle Name:ADEPEJU
Other - Last Name:OREDERU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:9 ELDRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-2308
Mailing Address - Country:US
Mailing Address - Phone:718-447-8085
Mailing Address - Fax:
Practice Address - Street 1:9 ELDRIDGE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-2308
Practice Address - Country:US
Practice Address - Phone:718-447-8085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY560531-1163WH0200X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide