Provider Demographics
NPI:1629339486
Name:ADEGBESAN, ANUOLUWAPO ENITAN
Entity Type:Individual
Prefix:
First Name:ANUOLUWAPO
Middle Name:ENITAN
Last Name:ADEGBESAN
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 1:2322 BRIGHTSEAT RD APT 7
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-3558
Mailing Address - Country:US
Mailing Address - Phone:202-423-0153
Mailing Address - Fax:202-722-7785
Practice Address - Street 1:114 50TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5307
Practice Address - Country:US
Practice Address - Phone:202-840-9776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide