Provider Demographics
NPI:1205548781
Name:ASEMOTA, IMUWAHEN N (RN)
Entity type:Individual
Prefix:
First Name:IMUWAHEN
Middle Name:N
Last Name:ASEMOTA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2154 KENNEDY DR # A
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-2900
Mailing Address - Country:US
Mailing Address - Phone:517-215-6436
Mailing Address - Fax:
Practice Address - Street 1:2154 KENNEDY DR # A
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-2900
Practice Address - Country:US
Practice Address - Phone:517-215-6436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704358682163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health