Provider Demographics
NPI:1972174928
Name:AGBORTOKO, FNU
Entity type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:AGBORTOKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6325 LANDOVER RD APT 204
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1330
Mailing Address - Country:US
Mailing Address - Phone:240-714-8095
Mailing Address - Fax:
Practice Address - Street 1:6325 LANDOVER RD APT 204
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1330
Practice Address - Country:US
Practice Address - Phone:240-714-8095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide