Provider Demographics
NPI:1770211120
Name:ADESANYA, OLUKEMI ESTHER (RN)
Entity type:Individual
Prefix:MRS
First Name:OLUKEMI
Middle Name:ESTHER
Last Name:ADESANYA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 FORREST HILLS DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-9654
Mailing Address - Country:US
Mailing Address - Phone:706-409-9796
Mailing Address - Fax:
Practice Address - Street 1:323 FORREST HILLS DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-9654
Practice Address - Country:US
Practice Address - Phone:706-409-9796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN285023163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-SurgicalGroup - Multi-Specialty