Provider Demographics
NPI:1033417555
Name:ADELEYE, ADEBOLA O (DNP, APN-C)
Entity Type:Individual
Prefix:DR
First Name:ADEBOLA
Middle Name:O
Last Name:ADELEYE
Suffix:
Gender:F
Credentials:DNP, APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4390 MONTGOMERY RD
Mailing Address - Street 2:ATTN: MINUTECLINIC CREDENTIALING 2100
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6068
Mailing Address - Country:US
Mailing Address - Phone:410-203-1700
Mailing Address - Fax:
Practice Address - Street 1:4390 MONTGOMERY RD
Practice Address - Street 2:ATTN: MINUTECLINIC CREDENTIALING 2100
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-6068
Practice Address - Country:US
Practice Address - Phone:410-203-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR194885363LF0000X
NJ26NJ00317000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily