Provider Demographics
NPI:1780203158
Name:ADELAJA, OLUBUNMI OLURONKE
Entity Type:Individual
Prefix:
First Name:OLUBUNMI
Middle Name:OLURONKE
Last Name:ADELAJA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 JURASSIC CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4745
Mailing Address - Country:US
Mailing Address - Phone:817-500-3516
Mailing Address - Fax:
Practice Address - Street 1:509 JURASSIC CT
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-4745
Practice Address - Country:US
Practice Address - Phone:817-500-3516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX331788164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse