Provider Demographics
NPI:1598410110
Name:ADESINA, OLUDOLA (RN)
Entity Type:Individual
Prefix:
First Name:OLUDOLA
Middle Name:
Last Name:ADESINA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 EAST AVE OFC 17
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-6245
Mailing Address - Country:US
Mailing Address - Phone:401-205-1054
Mailing Address - Fax:
Practice Address - Street 1:750 EAST AVE OFC 17
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-6245
Practice Address - Country:US
Practice Address - Phone:401-205-1054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN62769163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse