Healthcare Provider Details

I. General information

NPI: 1912815366
Provider Name (Legal Business Name): IMMACULATE ESENEK ADENEI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 L' ENFANT SQUARE SE
WASHINGTON, DC DC
20020
US

IV. Provider business mailing address

16320 EAGLE FLIGHT CIR
WOODBRIDGE VA
22191-6080
US

V. Phone/Fax

Practice location:
  • Phone: 202-269-2401
  • Fax:
Mailing address:
  • Phone: 571-343-1788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: