Provider Demographics
NPI:1558945329
Name:OLANIYI-ADEYEMO, BOSE OYRONKE
Entity Type:Individual
Prefix:
First Name:BOSE
Middle Name:OYRONKE
Last Name:OLANIYI-ADEYEMO
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:PO BOX 2754
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30156-9113
Mailing Address - Country:US
Mailing Address - Phone:678-290-0070
Mailing Address - Fax:678-290-0235
Practice Address - Street 1:4177 HAVENWOOD CT NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7343
Practice Address - Country:US
Practice Address - Phone:678-290-0070
Practice Address - Fax:678-290-0070
Is Sole Proprietor?:No
Enumeration Date:2021-05-08
Last Update Date:2021-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN083499164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse