Provider Demographics
NPI:1467901900
Name:ADEGUN, OMOLARA (DNP)
Entity Type:Individual
Prefix:DR
First Name:OMOLARA
Middle Name:
Last Name:ADEGUN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 WINDSOR RD
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-1878
Mailing Address - Country:US
Mailing Address - Phone:267-872-8847
Mailing Address - Fax:
Practice Address - Street 1:220 W CHELTEN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-3803
Practice Address - Country:US
Practice Address - Phone:215-310-7022
Practice Address - Fax:267-281-1744
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016532363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily