Provider Demographics
NPI:1760096820
Name:ADEKUSIBE, HELEN
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:ADEKUSIBE
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 1:5423 56TH AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-2400
Mailing Address - Country:US
Mailing Address - Phone:240-619-0109
Mailing Address - Fax:
Practice Address - Street 1:5423 56TH AVE APT 6
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-2400
Practice Address - Country:US
Practice Address - Phone:240-619-0109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00177720376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide