Provider Demographics
NPI:1023880531
Name:ADEGBENJO, SUSANAH ADEBOLA (DNP)
Entity type:Individual
Prefix:DR
First Name:SUSANAH
Middle Name:ADEBOLA
Last Name:ADEGBENJO
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3822 N ELM ST STE 102
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2596
Mailing Address - Country:US
Mailing Address - Phone:336-541-8120
Mailing Address - Fax:336-541-8130
Practice Address - Street 1:3822 N ELM ST STE 102
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2596
Practice Address - Country:US
Practice Address - Phone:336-541-8120
Practice Address - Fax:336-541-8130
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5019073363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily