Provider Demographics
NPI:1346567013
Name:ADEDOJA, MODUPE R (NP)
Entity Type:Individual
Prefix:
First Name:MODUPE
Middle Name:R
Last Name:ADEDOJA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RAFATU
Other - Middle Name:
Other - Last Name:YISA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 W MONROE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-1718
Mailing Address - Country:US
Mailing Address - Phone:281-725-7671
Mailing Address - Fax:
Practice Address - Street 1:111 W MONROE ST STE 300
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-1718
Practice Address - Country:US
Practice Address - Phone:205-536-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY628238163W00000X
TX875172163W00000X
TXAP138574363LF0000X
NYF346956363LF0000X
AZ288675363LF0000X, 363LP0808X
NY405441363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily