Provider Demographics
NPI:1174369508
Name:NNABUE, ADAEZE ASHLEY (OD)
Entity type:Individual
Prefix:DR
First Name:ADAEZE
Middle Name:ASHLEY
Last Name:NNABUE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10240 LAKE ARBOR WAY
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3113
Mailing Address - Country:US
Mailing Address - Phone:301-324-9500
Mailing Address - Fax:301-324-9502
Practice Address - Street 1:10240 LAKE ARBOR WAY
Practice Address - Street 2:
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-3113
Practice Address - Country:US
Practice Address - Phone:301-324-9500
Practice Address - Fax:301-324-9502
Is Sole Proprietor?:No
Enumeration Date:2024-07-04
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA3009152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist