Provider Demographics
NPI:1598264509
Name:ADEPETU, YETUNDE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:YETUNDE
Middle Name:
Last Name:ADEPETU
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 WIPKEY CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3233
Mailing Address - Country:US
Mailing Address - Phone:240-421-0664
Mailing Address - Fax:
Practice Address - Street 1:14200 LAUREL PARK DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5201
Practice Address - Country:US
Practice Address - Phone:410-724-3450
Practice Address - Fax:410-880-3178
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR194499363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily