Provider Demographics
NPI:1568818839
Name:RODRIGUEZ, ADETUTU K (LPN)
Entity Type:Individual
Prefix:MISS
First Name:ADETUTU
Middle Name:K
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 MANOR AVE
Mailing Address - Street 2:APT, 2D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-5928
Mailing Address - Country:US
Mailing Address - Phone:347-417-6340
Mailing Address - Fax:
Practice Address - Street 1:1036 MANOR AVE
Practice Address - Street 2:APT, 2D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-5928
Practice Address - Country:US
Practice Address - Phone:347-417-6340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY323910-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse