Provider Demographics
NPI:1659943967
Name:ADESIYAN, MOJISOLA CAROLINE
Entity Type:Individual
Prefix:MRS
First Name:MOJISOLA
Middle Name:CAROLINE
Last Name:ADESIYAN
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 1:2310 TUEMMLER AVE
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2748
Mailing Address - Country:US
Mailing Address - Phone:240-696-9324
Mailing Address - Fax:
Practice Address - Street 1:2310 TUEMMLER AVE
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-2748
Practice Address - Country:US
Practice Address - Phone:240-696-9324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00108677376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide