Provider Demographics
NPI:1801135520
Name:OBASEKI, FUNMI ANN (HHA, LPN)
Entity type:Individual
Prefix:
First Name:FUNMI
Middle Name:ANN
Last Name:OBASEKI
Suffix:
Gender:F
Credentials:HHA, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9785 GOODLUK ROAD
Mailing Address - Street 2:APT 7
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3341
Mailing Address - Country:US
Mailing Address - Phone:240-988-1753
Mailing Address - Fax:
Practice Address - Street 1:9785 GOOD LUCK RD
Practice Address - Street 2:APT 7
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3341
Practice Address - Country:US
Practice Address - Phone:240-988-1753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-01
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00061744376K00000X
DCLPN1006320164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No376K00000XNursing Service Related ProvidersNurse's Aide