Provider Demographics
NPI:1619237864
Name:AWESU, AZEEZAT ABIMBOLA
Entity Type:Individual
Prefix:MRS
First Name:AZEEZAT
Middle Name:ABIMBOLA
Last Name:AWESU
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 1:25 42ND STREET APT. 201
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:DC
Mailing Address - Zip Code:20019
Mailing Address - Country:US
Mailing Address - Phone:202-706-3784
Mailing Address - Fax:
Practice Address - Street 1:25 42ND ST NE APT 201
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-4573
Practice Address - Country:US
Practice Address - Phone:202-706-3784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service