Provider Demographics
NPI:1598101305
Name:ADEYEMI, ADEMILOLA SERENA
Entity Type:Individual
Prefix:
First Name:ADEMILOLA
Middle Name:SERENA
Last Name:ADEYEMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LOLA
Other - Middle Name:
Other - Last Name:ADEYEMI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3124 NW 16TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-4630
Mailing Address - Country:US
Mailing Address - Phone:405-361-8674
Mailing Address - Fax:
Practice Address - Street 1:3124 NW 16TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-4630
Practice Address - Country:US
Practice Address - Phone:405-361-8674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management