Provider Demographics
NPI:1902115470
Name:ADEGBOLA, RACHAEL O (RN)
Entity Type:Individual
Prefix:MS
First Name:RACHAEL
Middle Name:O
Last Name:ADEGBOLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3010 GABRIEL MICHAEL CT
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-3786
Mailing Address - Country:US
Mailing Address - Phone:718-916-4496
Mailing Address - Fax:281-809-3513
Practice Address - Street 1:3010 GABRIEL MICHAEL CT
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3786
Practice Address - Country:US
Practice Address - Phone:718-916-4496
Practice Address - Fax:281-809-3513
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-01
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY538277163WA2000X
TX929763163W00000X
CARN95164476163W00000X
171M00000X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163W00000XNursing Service ProvidersRegistered Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management