Provider Demographics
NPI:1982928891
Name:FAGBULE, ADENIKE FLORENCE
Entity Type:Individual
Prefix:
First Name:ADENIKE
Middle Name:FLORENCE
Last Name:FAGBULE
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 1:31 SCOTT CT
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-4946
Mailing Address - Country:US
Mailing Address - Phone:614-707-9587
Mailing Address - Fax:
Practice Address - Street 1:31 SCOTT CT
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-4946
Practice Address - Country:US
Practice Address - Phone:614-707-9587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH138382164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse