Provider Demographics
NPI:1093323081
Name:ADETULA, ADEFESOLA
Entity Type:Individual
Prefix:
First Name:ADEFESOLA
Middle Name:
Last Name:ADETULA
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 1:611 BLUECHALK DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-6036
Mailing Address - Country:US
Mailing Address - Phone:214-400-9394
Mailing Address - Fax:
Practice Address - Street 1:611 BLUECHALK DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-6036
Practice Address - Country:US
Practice Address - Phone:214-400-9394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX350885164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse