Provider Demographics
NPI:1780258129
Name:ADEBUTU, ADEBISI S
Entity type:Individual
Prefix:
First Name:ADEBISI
Middle Name:S
Last Name:ADEBUTU
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 1:2315 LINCOLN RD NE APT 11
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-1154
Mailing Address - Country:US
Mailing Address - Phone:202-925-7316
Mailing Address - Fax:
Practice Address - Street 1:2315 LINCOLN RD NE APT 11
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1154
Practice Address - Country:US
Practice Address - Phone:202-925-7316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNA0000803402376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide