Provider Demographics
NPI:1689399347
Name:IBE, ADANNA (RDN)
Entity Type:Individual
Prefix:MS
First Name:ADANNA
Middle Name:
Last Name:IBE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 MONROE ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-2611
Mailing Address - Country:US
Mailing Address - Phone:703-717-1263
Mailing Address - Fax:
Practice Address - Street 1:2809 MONROE ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-2611
Practice Address - Country:US
Practice Address - Phone:703-717-1263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2024-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3953133V00000X
DCDI100001161133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered