Provider Demographics
NPI:1659838357
Name:ADEWETAN, ARETHA (CNA/GNA)
Entity Type:Individual
Prefix:MS
First Name:ARETHA
Middle Name:
Last Name:ADEWETAN
Suffix:
Gender:F
Credentials:CNA/GNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7756
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-7756
Mailing Address - Country:US
Mailing Address - Phone:571-218-0913
Mailing Address - Fax:
Practice Address - Street 1:955 S ROLFE ST UNIT B
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-4540
Practice Address - Country:US
Practice Address - Phone:757-573-4134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-28
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00155559164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse