Provider Demographics
NPI:1881275386
Name:AGBEBI, OLUSEGUN OLUBUNMI
Entity type:Individual
Prefix:
First Name:OLUSEGUN
Middle Name:OLUBUNMI
Last Name:AGBEBI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 ORLEANS PL NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3402
Mailing Address - Country:US
Mailing Address - Phone:301-458-9127
Mailing Address - Fax:
Practice Address - Street 1:642 ORLEANS PL NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3402
Practice Address - Country:US
Practice Address - Phone:301-458-9127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMT0138521251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care