Provider Demographics
NPI:1639717333
Name:ADEDAYO, AMINAT FUNMILAYO (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:AMINAT
Middle Name:FUNMILAYO
Last Name:ADEDAYO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1247 TERRACE AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-5511
Mailing Address - Country:US
Mailing Address - Phone:651-235-4042
Mailing Address - Fax:
Practice Address - Street 1:671 VANDALIA ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1312
Practice Address - Country:US
Practice Address - Phone:651-696-5521
Practice Address - Fax:651-696-5544
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6979363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6979OtherMN LICENSE