Provider Demographics
NPI:1023261153
Name:ADESANYA, KUDIRAT OLUSHOLA
Entity type:Individual
Prefix:
First Name:KUDIRAT
Middle Name:OLUSHOLA
Last Name:ADESANYA
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 1:1014 MUELLER CT
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-8023
Mailing Address - Country:US
Mailing Address - Phone:614-604-7822
Mailing Address - Fax:614-604-7822
Practice Address - Street 1:1014 MUELLER CT
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-8023
Practice Address - Country:US
Practice Address - Phone:614-604-7822
Practice Address - Fax:614-604-7822
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-328239163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse