Provider Demographics
NPI:1053400200
Name:METIKO, ESTHER BOSEDE (NP)
Entity type:Individual
Prefix:MRS
First Name:ESTHER
Middle Name:BOSEDE
Last Name:METIKO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:ESTHER
Other - Middle Name:BOSEDE
Other - Last Name:OLORUNLONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:2525 CORLEY WOOD DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-4267
Mailing Address - Country:US
Mailing Address - Phone:919-851-7460
Mailing Address - Fax:919-250-4429
Practice Address - Street 1:10 SUNNYBROOK RD
Practice Address - Street 2:CLINIC A
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1808
Practice Address - Country:US
Practice Address - Phone:919-250-3069
Practice Address - Fax:919-250-4429
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201947363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ50515Medicare UPIN