Provider Demographics
NPI:1205458429
Name:ADESANYA, MOSUNMOLUWA (APRN)
Entity type:Individual
Prefix:
First Name:MOSUNMOLUWA
Middle Name:
Last Name:ADESANYA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 N 99TH AVE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-5324
Mailing Address - Country:US
Mailing Address - Phone:623-643-9678
Mailing Address - Fax:
Practice Address - Street 1:824 N 99TH AVE
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-5324
Practice Address - Country:US
Practice Address - Phone:623-643-9678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ239375363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health