Provider Demographics
NPI:1679313522
Name:ADISA, FUNMILAYO ESTHER
Entity type:Individual
Prefix:
First Name:FUNMILAYO
Middle Name:ESTHER
Last Name:ADISA
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 1:820 1ST ST NE STE 424
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4243
Mailing Address - Country:US
Mailing Address - Phone:202-506-1209
Mailing Address - Fax:
Practice Address - Street 1:820 1ST ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4243
Practice Address - Country:US
Practice Address - Phone:202-506-1209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD200003668374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide