Provider Demographics
NPI:1457181570
Name:ADETOLA, ADEKOLA (RN, BSN)
Entity type:Individual
Prefix:
First Name:ADEKOLA
Middle Name:
Last Name:ADETOLA
Suffix:
Gender:M
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 139TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-4114
Mailing Address - Country:US
Mailing Address - Phone:651-998-9454
Mailing Address - Fax:
Practice Address - Street 1:196 139TH AVE NW
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-4114
Practice Address - Country:US
Practice Address - Phone:651-998-9454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2264310163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse