Healthcare Provider Details

I. General information

NPI: 1609263268
Provider Name (Legal Business Name): ADEOLA ADEBUSOYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9419 3RD ST N
LAUREL MD
20723-1803
US

IV. Provider business mailing address

9419 3RD ST N
LAUREL MD
20723-1803
US

V. Phone/Fax

Practice location:
  • Phone: 240-601-8865
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR175407
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: