Healthcare Provider Details

I. General information

NPI: 1982928891
Provider Name (Legal Business Name): ADENIKE FLORENCE FAGBULE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2010
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 SCOTT CT
WESTERVILLE OH
43081-4946
US

IV. Provider business mailing address

31 SCOTT CT
WESTERVILLE OH
43081-4946
US

V. Phone/Fax

Practice location:
  • Phone: 614-707-9587
  • Fax:
Mailing address:
  • Phone: 614-707-9587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number138382
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: