Provider Demographics
NPI:1548433915
Name:FADELE, FLORENCE
Entity type:Individual
Prefix:
First Name:FLORENCE
Middle Name:
Last Name:FADELE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FLORENCE
Other - Middle Name:IDOWU
Other - Last Name:AKANGBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2690 NE KRESKY AVE
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-2412
Mailing Address - Country:US
Mailing Address - Phone:360-330-9565
Mailing Address - Fax:360-330-9560
Practice Address - Street 1:2690 NE KRESKY AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-2412
Practice Address - Country:US
Practice Address - Phone:360-330-9565
Practice Address - Fax:360-330-9560
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60002792363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily