Provider Demographics
NPI:1477037463
Name:ADEYEMI, BOLAJI
Entity Type:Individual
Prefix:
First Name:BOLAJI
Middle Name:
Last Name:ADEYEMI
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 1:8315 ADLER LAKE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-5271
Mailing Address - Country:US
Mailing Address - Phone:281-216-4758
Mailing Address - Fax:
Practice Address - Street 1:9950 WESTPARK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-5138
Practice Address - Country:US
Practice Address - Phone:713-266-0250
Practice Address - Fax:713-266-0256
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX600004163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse