Provider Demographics
NPI:1801672944
Name:ADEGBESAN, OLAYINKA (RN)
Entity type:Individual
Prefix:
First Name:OLAYINKA
Middle Name:
Last Name:ADEGBESAN
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 1:1861 SYBIL ST
Mailing Address - Street 2:
Mailing Address - City:CONLEY
Mailing Address - State:GA
Mailing Address - Zip Code:30288-1381
Mailing Address - Country:US
Mailing Address - Phone:678-886-5310
Mailing Address - Fax:
Practice Address - Street 1:1861 SYBIL ST
Practice Address - Street 2:
Practice Address - City:CONLEY
Practice Address - State:GA
Practice Address - Zip Code:30288-1381
Practice Address - Country:US
Practice Address - Phone:678-886-5310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN282400163WH0200X, 163WM0705X, 163WG0000X
251E00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based