Provider Demographics
NPI:1710561048
Name:ABON, MOTUNRAYO IMOLEAYO (CNA)
Entity type:Individual
Prefix:MS
First Name:MOTUNRAYO
Middle Name:IMOLEAYO
Last Name:ABON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:MOTUNRAYO
Other - Middle Name:IMOLEAYO
Other - Last Name:ABON
Other - Suffix:X
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3807 64TH AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1838
Mailing Address - Country:US
Mailing Address - Phone:443-600-8483
Mailing Address - Fax:
Practice Address - Street 1:3807 64TH AVE APT 202
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-1838
Practice Address - Country:US
Practice Address - Phone:443-600-8483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200001905374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide