Provider Demographics
NPI:1104223700
Name:KAYODE-ADEBOWALE, RACHEAL FADEKEMI
Entity type:Individual
Prefix:
First Name:RACHEAL
Middle Name:FADEKEMI
Last Name:KAYODE-ADEBOWALE
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 1:6600 LUZON AVE NW APT 511
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-3019
Mailing Address - Country:US
Mailing Address - Phone:240-898-7122
Mailing Address - Fax:
Practice Address - Street 1:6600 LUZON AVE NW APT511
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012
Practice Address - Country:US
Practice Address - Phone:240-898-7122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-25
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA10962374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide