Provider Demographics
NPI:1811469414
Name:AGBOOLA, MORENIKE ESTHER (NP)
Entity type:Individual
Prefix:
First Name:MORENIKE
Middle Name:ESTHER
Last Name:AGBOOLA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8126 OLD PHILA RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-2840
Mailing Address - Country:US
Mailing Address - Phone:443-418-6927
Mailing Address - Fax:
Practice Address - Street 1:1232 RACE RD STE 403
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-2386
Practice Address - Country:US
Practice Address - Phone:480-878-7806
Practice Address - Fax:443-732-0054
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR184584363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily