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NPI Code Detail

MEDICARE: ADEWUSI SAMSON KESHINRO LPN

MEDICARE: ADEWUSI SAMSON KESHINRO LPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical NurseLP053643AZ

General Provider Information

NPI Number : 1396378873
Entity Type Code : Individual
Provider Name (Legal Business Name) : ADEWUSI SAMSON KESHINRO LPN
Provider Business Mailing Address
First Line : 64 E BROADWAY RD STE 200
Second Line :
City : TEMPE
State : AZ
Zip : 85282-1377
Country : US
Telephone Number : 215-294-0792
Fax Number :
Provider Business Practice Location Address
First Line : 64 E BROADWAY RD STE 200
Second Line :
City : TEMPE
State : AZ
Zip : 85282-1377
Country : US
Telephone Number : 215-294-0792
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2020
Last Update Date : 02/12/2020

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