Provider Information for 1912740200
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Mrs. ABISOLA ADEPEGBA
Other Names:Former Name:GBEMISOLA OKANLAWONSex: Female
NPI: 1912740200
Last Updated: 2024-06-14
Certification Date: 2024-06-14
Certification Date: 2024-06-14
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1912740200 | ||||||||
| Enumeration Date | 2024-06-14 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 6635 NIU ST HONOLULU, HI 96818-7093 United States Phone: 301-675-1343 | Fax: | ||||||||
| Primary Practice Address | 6635 NIU ST HONOLULU, HI 96818-7093 United States Phone: 301-675-1343 | Fax: | ||||||||
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