Provider Demographics
NPI:1730626185
Name:AFENI, ABIMBOLA
Entity type:Individual
Prefix:
First Name:ABIMBOLA
Middle Name:
Last Name:AFENI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5013 TOWNSEND WAY
Mailing Address - Street 2:APT C4
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-1821
Mailing Address - Country:US
Mailing Address - Phone:240-486-3173
Mailing Address - Fax:
Practice Address - Street 1:5013 TOWNSEND WAY
Practice Address - Street 2:APT C4
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-1821
Practice Address - Country:US
Practice Address - Phone:240-486-3173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12183374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide