Provider Demographics
NPI:1457905929
Name:ADEFENWA, ESTHER ABIMBOLA
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:ABIMBOLA
Last Name:ADEFENWA
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 1:6255 64TH AVENUE #4
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-2966
Mailing Address - Country:US
Mailing Address - Phone:240-422-5649
Mailing Address - Fax:
Practice Address - Street 1:6255 64TH AVENUE #4
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-2966
Practice Address - Country:US
Practice Address - Phone:240-422-5649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC14593374U00000X
DCHHA14593374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide