Provider Demographics
NPI:1194206821
Name:JUNAID, ADEREMI A
Entity Type:Individual
Prefix:
First Name:ADEREMI
Middle Name:A
Last Name:JUNAID
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 1:1612 BLACK WILLOW TRL
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409-4528
Mailing Address - Country:US
Mailing Address - Phone:214-451-8727
Mailing Address - Fax:
Practice Address - Street 1:1612 BLACK WILLOW TRL
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:TX
Practice Address - Zip Code:75409-4528
Practice Address - Country:US
Practice Address - Phone:214-451-8727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX311362164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse