Provider Demographics
NPI:1760643746
Name:ADEOYE, THEO
Entity Type:Individual
Prefix:
First Name:THEO
Middle Name:
Last Name:ADEOYE
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 1:917 HEMS LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-5922
Mailing Address - Country:US
Mailing Address - Phone:817-368-4524
Mailing Address - Fax:817-468-0735
Practice Address - Street 1:917 HEMS LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-5922
Practice Address - Country:US
Practice Address - Phone:817-368-4524
Practice Address - Fax:817-468-0735
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-22
Last Update Date:2008-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX166982164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse