Provider Demographics
NPI:1871814640
Name:ADEFOLALU, ANIRE A (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:ANIRE
Middle Name:A
Last Name:ADEFOLALU
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 YANCEYVILLE ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-4043
Mailing Address - Country:US
Mailing Address - Phone:336-358-1528
Mailing Address - Fax:336-358-1582
Practice Address - Street 1:3231 YANCEYVILLE ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-4043
Practice Address - Country:US
Practice Address - Phone:336-358-1528
Practice Address - Fax:336-358-1582
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004730363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMA2176445OtherDEA