Provider Demographics
NPI:1629393632
Name:ADEDOTUN, OLUYEMISI OLAYINKA (APRN)
Entity Type:Individual
Prefix:MS
First Name:OLUYEMISI
Middle Name:OLAYINKA
Last Name:ADEDOTUN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 E FLAMINGO RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5018
Mailing Address - Country:US
Mailing Address - Phone:702-444-4690
Mailing Address - Fax:702-444-0977
Practice Address - Street 1:3430 E FLAMINGO RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5018
Practice Address - Country:US
Practice Address - Phone:702-444-4690
Practice Address - Fax:702-444-0977
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00276700364SF0001X, 364SH0200X
NVAPN001368363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
No364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVAPN001368OtherNV LICENSE