Provider Demographics
NPI:1659143360
Name:ADENIYI, NURUDEEN ADEMOLA
Entity Type:Individual
Prefix:
First Name:NURUDEEN
Middle Name:ADEMOLA
Last Name:ADENIYI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10255 COMMERCE DR STE 258
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7435
Mailing Address - Country:US
Mailing Address - Phone:126-020-6114
Mailing Address - Fax:317-520-3606
Practice Address - Street 1:10255 COMMERCE DR STE 258
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7435
Practice Address - Country:US
Practice Address - Phone:126-020-6114
Practice Address - Fax:317-520-3606
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23-015357-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health