Provider Demographics
NPI:1386227262
Name:ADEKUNLE, ADELOLA (FNP-C)
Entity Type:Individual
Prefix:
First Name:ADELOLA
Middle Name:
Last Name:ADEKUNLE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:PA
Mailing Address - Zip Code:19070-1219
Mailing Address - Country:US
Mailing Address - Phone:484-477-6262
Mailing Address - Fax:
Practice Address - Street 1:2210 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:PA
Practice Address - Zip Code:19070-1219
Practice Address - Country:US
Practice Address - Phone:484-477-6262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP023330363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty