Provider Demographics
NPI:1114153186
Name:ADEFOWOJU, ADEWALE (MSN, APN-BC)
Entity Type:Individual
Prefix:
First Name:ADEWALE
Middle Name:
Last Name:ADEFOWOJU
Suffix:
Gender:M
Credentials:MSN, APN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1379 BROOKFALL AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7013
Mailing Address - Country:US
Mailing Address - Phone:908-693-5036
Mailing Address - Fax:
Practice Address - Street 1:1379 BROOKFALL AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-7013
Practice Address - Country:US
Practice Address - Phone:908-693-5036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00196200363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner