Provider Demographics
NPI:1083186167
Name:ADETONA, MOTUNRAYO OLAYINKA (AGACNP)
Entity Type:Individual
Prefix:MRS
First Name:MOTUNRAYO
Middle Name:OLAYINKA
Last Name:ADETONA
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8443 OAKLAND HEIGHTS LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-1061
Mailing Address - Country:US
Mailing Address - Phone:401-996-4615
Mailing Address - Fax:
Practice Address - Street 1:16731 BEECHNUT ST APT 1301
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-6648
Practice Address - Country:US
Practice Address - Phone:401-996-4615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-29
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP14450363L00000X
TXAP144450363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX855388OtherRN LICENSE NU,BER