Provider Demographics
NPI:1750054508
Name:POPOOLA, ADENIKE ABIODUN
Entity Type:Individual
Prefix:
First Name:ADENIKE
Middle Name:ABIODUN
Last Name:POPOOLA
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 1:3404 LYNNE HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-3656
Mailing Address - Country:US
Mailing Address - Phone:443-527-1497
Mailing Address - Fax:
Practice Address - Street 1:3404 LYNNE HAVEN DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-3656
Practice Address - Country:US
Practice Address - Phone:443-527-1497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR224315363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily