Provider Demographics
NPI:1457122848
Name:AGBEMADI, WOLOBEE DEB (BSN, RN)
Entity Type:Individual
Prefix:
First Name:WOLOBEE
Middle Name:DEB
Last Name:AGBEMADI
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:WOLOBEE
Other - Middle Name:DEB
Other - Last Name:FARLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4633 COPPER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-2228
Mailing Address - Country:US
Mailing Address - Phone:161-244-2202
Mailing Address - Fax:
Practice Address - Street 1:4633 COPPER RIDGE DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55129-2228
Practice Address - Country:US
Practice Address - Phone:612-244-2202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2177106163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse