Provider Demographics
NPI:1053908111
Name:ADJEKUM, OLIVIA SERWAH
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:SERWAH
Last Name:ADJEKUM
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 1:12910 NITTANY LION CIR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-3586
Mailing Address - Country:US
Mailing Address - Phone:202-290-5319
Mailing Address - Fax:
Practice Address - Street 1:34 N CANNON AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-4919
Practice Address - Country:US
Practice Address - Phone:301-797-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR236268163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse