Provider Demographics
NPI:1104489293
Name:AKINBANI, KUBURAT ABIMBOLA (DC)
Entity type:Individual
Prefix:MRS
First Name:KUBURAT
Middle Name:ABIMBOLA
Last Name:AKINBANI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MISS
Other - First Name:KUBURAT
Other - Middle Name:ABIMBOLA
Other - Last Name:OLONISOWON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NIGERIA
Mailing Address - Street 1:4825 N CAPITOL ST NE UNIT APT 103
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-6747
Mailing Address - Country:US
Mailing Address - Phone:202-492-6104
Mailing Address - Fax:
Practice Address - Street 1:4825 N CAPITOL ST NE APT 103
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-6706
Practice Address - Country:US
Practice Address - Phone:202-492-6104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14356374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC91445700Medicaid