Provider Demographics
NPI:1073880282
Name:ADENIYI, ADENIKE OLUBUSAYO
Entity Type:Individual
Prefix:
First Name:ADENIKE
Middle Name:OLUBUSAYO
Last Name:ADENIYI
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 1:8867B N 95TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-7147
Mailing Address - Country:US
Mailing Address - Phone:708-415-1773
Mailing Address - Fax:
Practice Address - Street 1:8867B N. 95TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-7147
Practice Address - Country:US
Practice Address - Phone:708-415-1773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI313823-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse