Healthcare Provider Details

I. General information

NPI: 1356728232
Provider Name (Legal Business Name): ADETOKUNBO S FISHER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADETOKUNBO AGORO

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 S NEW ST SUITES C & D
DOVER DE
19904
US

IV. Provider business mailing address

64 SPRING CREEK DR
TOWNSEND DE
19734-9054
US

V. Phone/Fax

Practice location:
  • Phone: 302-734-3227
  • Fax: 302-734-0391
Mailing address:
  • Phone: 302-376-8011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0000782
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: