Healthcare Provider Details

I. General information

NPI: 1174316863
Provider Name (Legal Business Name): ADIATU BUSAIRU-MARTIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2025
Last Update Date: 05/26/2025
Certification Date: 05/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 IRVING ST NW
WASHINGTON DC
20422-0001
US

IV. Provider business mailing address

19059 ARROYO TER
LANSDOWNE VA
20176-8442
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-8582
  • Fax:
Mailing address:
  • Phone: 202-745-8582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024193580
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: