Provider Demographics
NPI:1609346469
Name:ADENUGA, ADEWALE ADENIRAN
Entity Type:Individual
Prefix:
First Name:ADEWALE
Middle Name:ADENIRAN
Last Name:ADENUGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9763 GOOD LUCK RD APT 8
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3330
Mailing Address - Country:US
Mailing Address - Phone:240-476-3212
Mailing Address - Fax:
Practice Address - Street 1:9763 GOOD LUCK RD APT 8
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3330
Practice Address - Country:US
Practice Address - Phone:240-476-3212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion