Healthcare Provider Details

I. General information

NPI: 1992375091
Provider Name (Legal Business Name): TOKUNBO L AGBANIGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 24TH ST NE
WASHINGTON DC
20018-2126
US

IV. Provider business mailing address

8700 NIGHTINGALE DR
LANHAM MD
20706-3951
US

V. Phone/Fax

Practice location:
  • Phone: 408-348-5255
  • Fax:
Mailing address:
  • Phone: 240-274-0775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCNA20211389
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: