MEDICARE: YETUNDE SEDEGBE RN

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
1	183700000X	Pharmacy Technician
2	163W00000X	Registered Nurse	RN1062099	DC

General Provider Information

NPI Number	:	1932312436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YETUNDE SEDEGBE RN

Provider Business Mailing Address
First Line	:	2811 PENNSYLVANIA AVE SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-3865
Country	:	US
Telephone Number	:	202-894-6811
Fax Number	:

Provider Business Practice Location Address
First Line	:	2811 PENNSYLVANIA AVE SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-3865
Country	:	US
Telephone Number	:	202-894-6811
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	06/07/2023

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