Provider Demographics
NPI:1649981325
Name:ADEOGUN, NIKITA
Entity type:Individual
Prefix:
First Name:NIKITA
Middle Name:
Last Name:ADEOGUN
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 1:300 S LAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-5222
Mailing Address - Country:US
Mailing Address - Phone:919-756-9149
Mailing Address - Fax:
Practice Address - Street 1:300 S LAYTON AVE
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-5222
Practice Address - Country:US
Practice Address - Phone:919-756-9149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC47720716172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Multi-Specialty