Provider Demographics
NPI:1790320372
Name:ADEWUMI, AFOLAKE A
Entity type:Individual
Prefix:
First Name:AFOLAKE
Middle Name:A
Last Name:ADEWUMI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14031 BURNHAVEN DR STE 106
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4474
Mailing Address - Country:US
Mailing Address - Phone:952-955-4110
Mailing Address - Fax:952-995-7482
Practice Address - Street 1:14031 BURNHAVEN DR STE 106
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4474
Practice Address - Country:US
Practice Address - Phone:952-955-4110
Practice Address - Fax:952-995-7482
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-232337-4163WP0808X
MN7058363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health