Provider Demographics
NPI:1689029514
Name:KUTEYI, ADELANKE VERONICA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ADELANKE
Middle Name:VERONICA
Last Name:KUTEYI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 KENT RD
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-3210
Mailing Address - Country:US
Mailing Address - Phone:215-456-2738
Mailing Address - Fax:215-456-2729
Practice Address - Street 1:1315 WINDRIM AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-2710
Practice Address - Country:US
Practice Address - Phone:215-456-2738
Practice Address - Fax:215-456-2729
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN291674164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1528171790Medicaid