Provider Demographics
NPI:1164974762
Name:OBAYANJU, ADEOLA GABRIEL (DNP, APN, AGPNP-BC)
Entity Type:Individual
Prefix:DR
First Name:ADEOLA
Middle Name:GABRIEL
Last Name:OBAYANJU
Suffix:
Gender:M
Credentials:DNP, APN, AGPNP-BC
Other - Prefix:DR
Other - First Name:ADEOLA
Other - Middle Name:
Other - Last Name:OBAYANJU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, APN, AGPCNP-BC
Mailing Address - Street 1:333 N SUMMIT ST FL 15
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-2615
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1385 CHEWS LANDING RD
Practice Address - Street 2:
Practice Address - City:LAUREL SPRINGS
Practice Address - State:NJ
Practice Address - Zip Code:08021-2760
Practice Address - Country:US
Practice Address - Phone:800-427-1902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-30
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR12639700163W00000X
NJ26NJ01268100363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse